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The association of depressive symptoms and ischemic heart disease in older adults is not moderated by gender, marital status or education

International Journal of Public Health volume 57, pages 79–85 (2012)Cite this article

Abstract

Objectives

To investigate whether the association of depression and ischemic heart disease (IHD) is moderated by gender, marital status or education.

Methods

Data from the 1998 Medicare Health Outcome Survey (HOS) with a 2 year follow-up were re-analyzed. 63,965 older adults who had not reported IHD at baseline were included. Logistic regression analysis modelled the effects of depression, somatic risk factors, and demographic variables on IHD after 2 years.

Results

Two year reported incidence of IHD was 6.2%. Depression was associated with a 1.53-fold risk of developing IHD after controlling for somatic risk factors and demographic variables. Male gender, lower than high-school education, and being married were associated with IHD. Neither of these variables yielded significant interactions with depression, nor did any of the higher-order interaction terms.

Conclusions

The association of depression and IHD seems independent from pivotal demographic variables. Possibly the impact of psychosocial factors in this sample of older people is weak compared to medical conditions and age. Also the possibility exists that a common factor such as a shared genetic vulnerability contributes to both depressive symptoms and IHD.

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References

  • Ariyo AA, Haan M, Tangen CM, Rutledge JC, Cushman M, Dobs A, Furberg CD (2000) Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans Cardiovascular Health Study Collaborative Research Group. Circulation 102:1773–1779

    PubMed  CAS  Google Scholar 

  • Barth J, Schumacher M, Herrmann-Lingen C (2004) Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 66:802–813

    PubMed  Article  Google Scholar 

  • Carney RM, Freedland KE, Steinmeyer B, Blumenthal JA, de Jonge P, Davidson KW, Czajkowski SM, Jaffe AS (2009) History of depression and survival after acute myocardial infarction. Psychosom Med 71:253–259

    PubMed  Article  CAS  Google Scholar 

  • Frasure-Smith N, Lespérance F (2006) Recent evidence linking coronary heart disease and depression. Can J Psychiatry 51:730–737

    PubMed  Google Scholar 

  • Frasure-Smith N, Lespérance F, Juneau M, Talajic M, Bourassa MG (1999) Gender, depression, and 1 year prognosis after myocardial infarction. Psychosom Med 61:26–37

    PubMed  CAS  Google Scholar 

  • Frasure-Smith N, Lespérance F, Gravel G, Masson A, Juneau M, Talajic M, Bourassa M (2000) Social support, depression, and mortality during the first year after myocardial infarction. Circulation 101:1919–1924

    PubMed  CAS  Google Scholar 

  • Health Services Advisory Group (2005) Medicare Health Outcomes Survey. Cohort I Analytic public use file. Data user’s guide (http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/23380/documentation;jsessionid=FB34C93F71E2143784729031396BDD0F)

  • Herrmann-Lingen C, Buss U (2006) Anxiety and depression in patients with coronary heart disease. In: Jordan J, Bardé B, Zeiher A (eds) Contributions toward evidence-based psychocardiology: a systematic review of the literature. APA, Washington, pp 125–157

  • Horsten M, Mittleman MA, Wamala SP, Schenck-Gustafsson, Orth-Gomér K (2000) Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Heart Risk Study. Eur Heart J 21:1072–1080

  • Huffman JC, Celano CM, Januzzi JL (2010) The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatr Dis Treat 6:123–136

    PubMed  Article  Google Scholar 

  • Kiecolt-Glaser JK, Newton TL (2001) Marriage and health: his and hers. Psychol Bull 127:472–503

    PubMed  Article  CAS  Google Scholar 

  • Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF (2004) Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med 66:305–315

    PubMed  Article  Google Scholar 

  • Lillard LA, Panis CWA (1996) Marital status and mortality: the role of health. Demography 33(3):313–327

    PubMed  Article  CAS  Google Scholar 

  • Marmot MG, Shipley MJ (1996) Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. BMJ 313:1177–1180

    PubMed  Article  CAS  Google Scholar 

  • Marzari C, Maggi S, Manzato E, Destro C, Noale M, Bianchi D, Minicuci N, Farchi G, Baldereschi M, Di Carlo A, Crepaldi G (2005) Depressive symptoms and development of coronary heart disease events: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci 60:85–92

    PubMed  Article  Google Scholar 

  • McCaffery JM, Frasure-Smith N, Bubé MP, Théroux P, Rouleau GA, Duan QL, Lespérance F (2006) Common genetic vulnerability to depressive symptoms and coronary artery disease. Psychosom Med 68:187–200

    PubMed  Article  CAS  Google Scholar 

  • Meisinger C, Kandler U, Ladwig KH (2009) Living alone is associated with an increased risk of type 2 diabetes mellitus in men but not women from the general population: the MONICA/KORA Augsburg Cohort Study. Psychosom Med 71:784–788

    PubMed  Article  Google Scholar 

  • Mendes de Leon CF, Krumholz HM, Seeman TS, Vaccarino V, Williams CS, Kasl SV, Berkman LF (1998) Depression and risk of coronary heart disease in elderly men and women: new haven EPESE, 1982–1991 established populations for the epidemiologic studies of the elderly. Arch Intern Med 158:2341–2348

    PubMed  Article  CAS  Google Scholar 

  • Meyer T, Cooper J, Raspe H (2007) Disabling low back pain and depression in the community-dwelling elderly: a prospective study. Spine 32:2380–2386

    PubMed  Article  Google Scholar 

  • Nabi H, Kivimaki M, Suominen S, Koskenvuo M, Singh-Manoux A, Vahtera J (2010) Does depression predict coronary heart disease and cerebrovascular disease equally well? The health and social support prospective cohort study. Int J Epidemiol 39:1016–1024

    PubMed  Article  Google Scholar 

  • Orth-Gomér K, Albus Ch, Bagés N, DeBacker G, Deter HC, Herrmann -Lingen Ch, Oldenburg B, Sans S, Williams RB, Schneiderman N (2005) Psychosocial considerations in the European guidelines for prevention of cardiovascular diseases in clinical practice: 3rd joint task force. Int J Behav Med 12:132–141

    PubMed  Article  Google Scholar 

  • Panagiotakos DB, Pitsavos C, Kogias Y, Mantas Y, Zombolos S, Antonoulas A, Giannopoulos G, Chrysohoou C, Stefanadis C (2008) Marital status, depressive episodes, and short-term prognosis of patients with acute coronary syndrome: Greek study of acute coronary syndrome (GREECS). Neuropsychiatr Dis Treat 4:425–432

    PubMed  Article  Google Scholar 

  • Parashar S, Rumsfeld JS, Reid KJ, Buchanan D, Dawood N, Khizer S, Lichtman J, Vaccarino V, PREMIER Registry Investigators (2009) Impact of depression on sex differences in outcome after myocardial infarction. Circ Cardiovasc Qual Outcomes 2(1):33–40

    PubMed  Article  Google Scholar 

  • Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S, INTERHEART investigators (2004) Association of pychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 364(9438):953–962

    PubMed  Article  Google Scholar 

  • Rugulies R (2002) Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 23:51–61

    PubMed  Article  Google Scholar 

  • Sbarra DA (2009) Marriage protects men from clinically meaningful elevations in C-reactive protein: results from the National Social Life, Health, and Aging Project (NSHAP). Psychosom Med 71:828–835

    PubMed  Article  CAS  Google Scholar 

  • Skala JA, Freedland KE, Carney RM (2006) Coronary heart disease and depression: a review of recent mechanistic research. Can J Psychiatry 51:738–745

    PubMed  Google Scholar 

  • Stewart JC, Rand KL, Muldoon MF, Kamarck TW (2009) A prospective evaluation of the directionality of the depression-inflammation relationship. Brain Behav Immun 23(7):936–944

    PubMed  Article  CAS  Google Scholar 

  • Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT (2008) Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry 165:515–523

    PubMed  Article  Google Scholar 

  • Thurston RC, Kubzansky LD, Kawachi I, Berkman L (2005) Is the association between socioeconomic position and coronary heart disease stronger in women than in men? Am J Epidemiol 162:57–65

    PubMed  Article  Google Scholar 

  • Vaccarino V, Johnson BD, Sheps DS, Reis SE, Kelsey SF, Bittner V, Rutledge T, Shaw LJ, Sopko G, Bairey Merz CN (2007) 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 50(21):2044–2050

    PubMed  Article  Google Scholar 

  • Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A (2007) Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 22:613–626

    PubMed  Article  Google Scholar 

  • Wulsin LR, Singal BM (2003) Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 65:201–210

    PubMed  Article  Google Scholar 

  • Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364(9438):937–952

    PubMed  Article  Google Scholar 

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Conflict of interest

The authors declare that they have no competing interests.

Author information

Affiliations

  1. Department of Quality Management and Social Medicine, University Medical Center of Freiburg, Engelbergerstrasse 21, 79106, Freiburg, Germany

    Oskar Mittag

  2. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Thorsten Meyer

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  1. Oskar Mittag
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  2. Thorsten Meyer
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Correspondence to Oskar Mittag.

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Mittag, O., Meyer, T. The association of depressive symptoms and ischemic heart disease in older adults is not moderated by gender, marital status or education. Int J Public Health 57, 79–85 (2012). https://doi.org/10.1007/s00038-011-0256-6

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  • DOI: https://doi.org/10.1007/s00038-011-0256-6

Keywords

  • Depression
  • Coronary heart disease
  • Gender
  • Marital status
  • Education
  • Epidemiology