title: Depression is a risk factor for incident coronary heart disease in women: An 18-year longitudinal study.
abstract: BACKGROUND
  According to a recent position paper by the American Heart Association, it remains unclear whether depression is a risk factor for incident Coronary Heart Disease (CHD). We assessed whether a depressive disorder independently predicts 18-year incident CHD in women.
  
  
  METHODS
  A prospective longitudinal study of 860 women enrolled in the Geelong Osteoporosis Study (1993-2011) was conducted. Participants were derived from an age-stratified, representative sample of women (20-94 years) randomly selected from electoral rolls in South-Eastern Australia. The exposure was a diagnosis of a depressive disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Outcomes data were collected from hospital medical records: (1) PRIMARY OUTCOME: a composite measure of cardiac death, non-fatal Myocardial Infarction or coronary intervention. (2) Secondary outcome: any cardiac event (un/stable angina, cardiac event not otherwise defined) occurring over the study period.
  
  
  RESULTS
  Seven participants were excluded based on CHD history. Eighty-three participants (9.6%) recorded ≥1 cardiac event over the study period; 47 had a diagnosis that met criteria for inclusion in the primary analysis. Baseline depression predicted 18-year incidence, adjusting for (1) anxiety (adj. OR:2.39; 95% CIs:1.19-4.82), plus (2) typical risk factors (adj. OR:3.22; 95% CIs:1.45-6.93), plus (3) atypical risk factors (adj. OR:3.28; 95% CIs:1.36-7.90). This relationship held when including all cardiac events. No relationship was observed between depression and recurrent cardiac events.
  
  
  CONCLUSIONS
  The results of this study support the contention that depression is an independent risk factor for CHD incidence in women. Moreover, the strength of association between depression and CHD incidence was of a greater magnitude than any typical and atypical risk factor.
authors.affiliation: Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia. Electronic address: adrienne.oneil@unimelb.edu.au.
authors.forename: Adrienne
authors.initials: A
authors.lastname: O'Neil
authors.affiliation: Department of Psychology, University of California, Berkeley, CA, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Fisher
authors.affiliation: Barwon Health, Geelong Hospital, Geelong, VIC, Australia; Monash Health, Melbourne, VIC, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Kibbey
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Parkville, VIC, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Felice N
authors.initials: FN
authors.lastname: Jacka
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong Hospital, Geelong, VIC, Australia; Department of Psychiatry & Behavioral Medicine, Stanford University & Palo Alto University, CA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowicz
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia.
authors.forename: Lana J
authors.initials: LJ
authors.lastname: Williams
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Stuart
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Orygen Youth Health Research Centre, Parkville, VIC, Australia; Mental Health Research Institute, Parkville, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lewandowski
authors.affiliation: Department of Psychiatry & Behavioral Medicine, Stanford University & Palo Alto University, CA, USA.
authors.forename: Craig B
authors.initials: CB
authors.lastname: Taylor
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia; Western Medical School, The University of Melbourne, St Albans, VIC, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology
keywords: Coronary heart disease; Depression; Prevention; Risk factor; Women