title: Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients, a cohort study.
abstract: BACKGROUND
  To determine if major depressive disorder (MDD) in older primary care patients is an independent risk factor for cardiovascular events.
  
  
  METHODS
  A cohort of 143 primary care patients with depression and 139 non-depressed controls without depression (both aged over 55 years, matched for age and gender) from the Netherlands was evaluated for 2 years. MDD was diagnosed according to DSM-IV-criteria. During the follow-up period, information was collected on physical health, depression status and behavioural risk factors. CVD end points were assessed with validated annual questionnaires and were crosschecked with medical records.
  
  
  RESULTS
  Thirty-four participants experienced a cardiovascular event, of which 71% were depressed: 27/134 with MDD (20.1%) and 9/137 controls (6.6%). MDD was associated with a hazard ratio of 2.83 (p value 0,004, 95% CI 1.32 to 6.05) for cardiovascular events. After adjustment for cardiovascular medication, the hazard ratio was 2.46 (95% CI 1.14 to 5.30).
  
  
  CONCLUSIONS
  In a 2-year follow-up period, baseline MDD increased the risk for CVD in older primary care patients compared with controls, over and above well-known cardiovascular risk factors.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Health Care Research, VU University Medical Center, Amsterdam, The Netherlands. hwj.vanmarwijk@vumc.nl.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: Rotterdam Business School, P.O. box 2941, , 1000 SN, Rotterdam, The Netherlands. koenkooy@aol.com.
authors.forename: Koen G
authors.initials: KG
authors.lastname: van der Kooy
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Psychiatry, EMGO institute for Health and Care Research, VU University medical center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands. A.Beekman@ggzingeest.nl.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Health Care Research, VU University Medical Center, Amsterdam, The Netherlands. hpj.vanhout@vumc.nl.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors