title: Depression leads to incident vascular disease: evidence for the relevance to primary care.
abstract: BACKGROUND
  Depression is a known risk factor for vascular disease in community cohorts and in large, system-wide, health care databases. It is not known if the association between depression and incident vascular disease exists when patient data is restricted to depression presenting in primary care.
  
  
  METHODS
  Data were from a medical record registry capturing all primary care encounters at a large academic medical practice from 2008 to 2013. From 27,225 registry patients, we identified 7383 patients free of vascular disease for 18 months prior to baseline. ICD-9-CM codes were used to define depression and vascular disease. Volume of health care use, demographics and comorbid diagnoses were obtained from the patient data registry. Cox proportional hazard models with time dependent covariates were computed to measure the association between depression and incident vascular disease before and after adjusting for covariates.
  
  
  RESULTS
  Of the 7383 patients initially free of vascular disease, 14% were diagnosed with depression and 8.6% developed vascular disease. Incident vascular disease was significantly (P < 0.01) higher among patients with depression (12.7%) compared to those without depression (7.9%). In the unadjusted model, depression was associated with a 49% increased risk of developing vascular disease (odds ratio [OR] = 1.49; 95% confidence interval [CI]: 1.19-1.86) and this association remained significant after adjusting for all potential confounders (OR = 1.28; 95% CI: 1.02-1.62).
  
  
  CONCLUSIONS
  The association between depression and incident vascular disease is observed in patients diagnosed and managed by primary care physicians. Primary care physicians have an opportunity to impact this association. Guidelines for primary care providers are needed to prompt aggressive depression treatment and vascular disease screening.
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA scherrjf@slu.edu.
authors: Jeffrey F
authors: JF
authors: Scherrer
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
authors: Joanne
authors: J
authors: Salas
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
authors: Jay A
authors: JA
authors: Brieler
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
authors: Bobbi J
authors: BJ
authors: Miller
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
authors: Dixie
authors: D
authors: Meyer
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
authors: F David
authors: FD
authors: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005194:Family Practice; D005260:Female; D006801:Humans; D015994:Incidence; D007388:Internal Medicine; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011320:Primary Health Care; D012042:Registries; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology*
keywords: Depression; heart disease; primary care; stroke; vascular disease.