Advertisement

Relation of Inflammation to Depression and Incident Coronary Heart Disease (from the Canadian Nova Scotia Health Survey [NSHS95] Prospective Population Study)

Published:January 27, 2009DOI:https://doi.org/10.1016/j.amjcard.2008.11.035
      Numerous studies have found that depression was a strong independent risk factor for incident coronary heart disease (CHD), with increasing risk in those with higher levels of depressive symptoms. The association between measures of inflammation (C-reactive protein, interleukin-6, and soluble intracellular adhesion molecule-1), depressive symptoms, and CHD incidence was examined in 1,794 subjects of the population-based Canadian Nova Scotia Health Survey. There were 152 incident CHD events (8.5%; 141 nonfatal, 11 fatal) during the 15,514 person-years of observation (incidence rate 9.8 events/1,000 person-years). Depression and inflammation were correlated at baseline and each significantly predicted CHD in separate models. When both risk factors were in the same model, each remained significant. The association between depressed group by the Center for Epidemiological Studies-Depression scale (score ≥10 vs 0 to 9) and CHD incidence (hazard rate 1.60, 95% confidence interval 1.12 to 2.27) was not reduced by the addition of inflammatory markers to the model (hazard rate 1.59, 95% confidence interval 1.12 to 2.26). Findings were similar after adjustment for aspirin, lipid-lowering medication, or antidepressant use, and the association did not vary by gender, smoking status, age, obesity, cardiovascular medication use, or antidepressant use. In conclusion, increased inflammation explained only a very small proportion of the association between depression and incident CHD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nicholson A.
        • Kuper H.
        • Hemingway H.
        Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies.
        Eur Heart J. 2006; 27: 2763-2774
        • Suls J.
        • Bunde J.
        Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions.
        Psychol Bull. 2005; 131: 260-300
        • Van der Kooy K.
        • van Hout H.
        • Marwijk H.
        • Marten H.
        • Stehouwer C.
        • Beekman A.
        Depression and the risk for cardiovascular diseases: systematic review and meta analysis.
        Int J Geriatr Psychiatry. 2007; 22: 613-626
        • Ridker P.M.
        • Cushman M.
        • Stampfer M.J.
        • Tracy R.P.
        • Hennekens C.H.
        Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.
        N Engl J Med. 1997; 336: 973-979
        • Ridker P.M.
        • Hennekens C.H.
        • Buring J.E.
        • Rifai N.
        C-Reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.
        N Engl J Med. 2000; 342: 836-843
        • Ridker P.M.
        • Hennekens C.H.
        • Roitman-Johnson B.
        • Stampfer M.J.
        • Allen J.
        Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men.
        Lancet. 1998; 351: 88-92
        • Empana J.P.
        • Sykes D.H.
        • Luc G.
        • Juhan-Vague I.
        • Arveiler D.
        • Ferrieres J.
        • Amouyel P.
        • Bingham A.
        • Montaye M.
        • Ruidavets J.B.
        • et al.
        Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).
        Circulation. 2005; 111: 2299-2305
        • Panagiotakos D.B.
        • Pitsavos C.
        • Chrysohoou C.
        • Tsetsekou E.
        • Papageorgiou C.
        • Christodoulou G.
        • Stefanadis C.
        Inflammation, coagulation, and depressive symptomatology in cardiovascular disease-free people; the ATTICA study.
        Eur Heart J. 2004; 25: 492-499
        • Shimbo D.
        • Chaplin W.
        • Crossman D.
        • Haas D.
        • Davidson K.W.
        Role of depression and inflammation in incident coronary heart disease events.
        Am J Cardiol. 2005; 96: 1016-1021
        • Elovainio M.
        • Keltikangas-Jarvinen L.
        • Pulkki-Raback L.
        • Kivimaki M.
        • Puttonen S.
        • Viikari L.
        • Rasanen L.
        • Mansikkaniemi K.
        • Viikari J.
        • Raitakari O.T.
        Depressive symptoms and C-reactive protein: the Cardiovascular Risk in Young Finns Study.
        Psychol Med. 2006; 36: 797-805
        • Ford D.E.
        • Erlinger T.P.
        Depression and C-reactive protein in US adults: data from the Third National Health and Nutrition Examination Survey.
        Arch Intern Med. 2004; 164: 1010-1114
        • Penninx B.W.
        • Kritchevsky S.B.
        • Yaffe K.
        • Newman A.B.
        • Simonsick E.M.
        • Rubin S.
        • Ferrucci L.
        • Harris T.
        • Pahor M.
        Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study.
        Biol Psychiatry. 2003; 54: 566-572
        • Vaccarino V.
        • Johnson B.D.
        • Sheps D.S.
        • Reis S.E.
        • Kelsey S.F.
        • Bittner V.
        • Rutledge T.
        • Shaw L.J.
        • Sopko G.
        • Bairey Merz C.N.
        Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE study.
        J Am Coll Cardiol. 2007; 50: 2044-2050
        • MacLean D.
        • Scott J.
        • Beanlands H.
        • Hood R.
        • Cogdon A.
        • LeBlanc B.
        • Davidson K.W.
        • Mills T.
        • Wolf H.K.
        • Elliott D.
        • Kephart G.
        • Farquhar J.W.
        The 1995 Nova Scotia Health Survey.
        Dalhousie University, Heart Health Nova Scotia, Halifax, Nova Scotia1996
        • Lawson B.J.
        Evaluation of non-response bias in the Nova Scotia Health Survey 1995.
        Dalhousie University, Halifax, Nova Scotia, Canada1999
        • Pearson T.A.
        • Mensah G.A.
        • Alexander R.W.
        • Anderson J.L.
        • Cannon III, R.O.
        • Criqui M.
        • Fadl Y.Y.
        • Fortmann S.P.
        • Hong Y.
        • Myers G.L.
        • et al.
        • Centers for Disease Control and Prevention, American Heart Association
        Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
        Circulation. 2003; 107: 499-511
        • Rowan P.J.
        • Haas D.
        • Campbell J.A.
        • Maclean D.R.
        • Davidson K.W.
        Depressive symptoms have an independent, gradient risk for coronary heart disease incidence in a random, population-based sample.
        Ann Epidemiol. 2005; 15: 316-320
        • Connelly P.W.
        • MacLean D.R.
        • Horlick L.
        • O'Connor B.
        • Petrasovits A.
        • Little J.A.
        Plasma lipids and lipoproteins and the prevalence of risk for coronary heart disease in Canadian adults.
        CMAJ. 1992; 146: 1977-1987
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • WHO Collaborating Centre for Drug Statistics Methodology
        Anatomical Therapeutic Chemical (ATC) classification index.
        WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway1995
        • Radloff L.S.
        The CES-D Scale: A self-report depression scale for research in the general population.
        Appl Psychol Meas. 1977; 1: 385-401
        • Yeh E.T.
        • Willerson J.T.
        Coming of age of C-reactive protein: using inflammation markers in cardiology.
        Circulation. 2003; 107: 370-371
        • Ishikawa S.
        • Kayaba K.
        • Gotoh T.
        • Nakamura Y.
        • Kario K.
        • Ito Y.
        • Kajii E.
        Comparison of C-reactive protein levels between serum and plasma samples on long-term frozen storage after a 13.8 year interval: the JMS Cohort Study.
        J Epidemiol. 2007; 17: 120-124
        • Manga P.
        • Broyles R.W.
        • Angus D.E.
        The determinants of hospital utilization under a universal public insurance program in Canada.
        Med Care. 1987; 25: 658-670
        • Wilson P.W.
        • D'Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Lin D.Y.
        • Wei L.J.
        • Ying Z.
        Checking the Cox model with cumulative sums of martingale-based residuals.
        Biometrika. 1993; 80: 557-572
        • Ladwig K.H.
        • Marten-Mittag B.
        • Lowel H.
        • Doring A.
        • Koenig W.
        Influence of depressive mood on the association of CRP and obesity in 3205 middle aged healthy men.
        Brain Behav Immun. 2003; 17: 268-275
        • Surtees P.G.
        • Wainwright N.W.
        • Luben R.N.
        • Wareham N.J.
        • Bingham S.A.
        • Khaw K.T.
        Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom Prospective Cohort Study.
        Am J Psychiatry. 2008; 165: 515-523
        • Ladwig K.H.
        • Marten-Mittag B.
        • Lowel H.
        • Doring A.
        • Koenig W.
        C-Reactive protein, depressed mood, and the prediction of coronary heart disease in initially healthy men: results from the MONICA-KORA Augsburg Cohort Study 1984–1998.
        Eur Heart J. 2005; 26: 2537-2542
        • Nabi H.
        • Singh-Manoux A.
        • Shipley M.
        • Gimeno D.
        • Marmot M.G.
        • Kivimaki M.
        Do psychological factors affect inflammation and incident coronary heart disease: the Whitehall II Study.
        Arterioscler Thromb Vasc Biol. 2008; 28: 1398-1406
        • Kraemer H.C.
        • Stice E.
        • Kazdin A.
        • Offord D.
        • Kupfer D.
        How do risk factors work together?.
        Am J Psychiatry. 2001; 158: 848-856
        • Lett H.S.M.A.
        • Blumenthal J.A.P.
        • Babyak M.A.P.
        • Sherwood A.P.
        • Strauman T.P.
        • Robins C.P.
        • Newman M.F.M.D.
        Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment.
        Psychosom Med. 2004; 66: 305-315
        • Pizzi C.
        • Manzoli L.
        • Mancini S.
        • Costa G.M.
        Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function.
        Eur Heart J. 2008; 29: 1110-1117
        • Rieckmann N.
        • Gerin W.
        • Kronish I.M.
        • Burg M.M.
        • Chaplin W.F.
        • Kong G.
        • Lesperance F.
        • Davidson K.W.
        Course of depressive symptoms and medication adherence after acute coronary syndromes: an electronic medication monitoring study.
        J Am Coll Cardiol. 2006; 48: 2218-2222