title: The association between mood and anxiety disorders, and coronary heart disease in Brazil: a cross-sectional analysis on the Brazilian longitudinal study of adult health (ELSA-Brasil).
abstract: BACKGROUND
  Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations.
  
  
  METHODS
  Participants included 15,105 civil servants aged 35 to 74 at baseline (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals.
  
  
  RESULTS
  Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) - symptoms present, but diagnostic threshold not reached - are associated with a 1.5-fold increase in CHD, after full adjustment for covariates.
  
  
  CONCLUSIONS
  The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil ; School of Psychology and Discipline of Psychiatry, University of Sydney, Sydney, NSW Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kemp
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
authors.forename: Andre R
authors.initials: AR
authors.lastname: Brunoni
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre Brazil.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Nunes
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Hospital das Clínicas and Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte Brazil.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
keywords: anxiety disorders; coronary heart disease; disorder comorbidity; major depressive disorder