1. Background/Rationale: This proposal will provide empirical evidence for mechanisms that lead from and interact with depression to increase risk for incident heart disease and subsequently provide evidence for the need to treat depression as a serious cardiovascular risk factor that deserves the same level of VA fiscal and physician intervention as that already in practice for traditional risk factors such as diabetes and hypertension.
2. Objectives A. Determine if depressed patients with a comorbid anxiety disorder have a significantly greater risk for incident heart disease than those with depression alone. B. Determine if depressed substance dependent patients will be at greater risk than patients with depression alone. C. Determine if there is evidence of a dose response relationship between the number of comorbid psychiatric disorders and the risk for incident heart disease. D. Determine if the number of depressive episodes, longer duration and severity and somatic symptoms will be positively associated with incident heart disease. E. Determine if heavy smoking, poor diet, lack of exercise and inadequate treatment of depression will be in the causal pathway from depression to heart disease.
3. Methods: Objectives A-C will be addressed by using VA administrative data including patient treatment files, pharmacy benefits data, laboratory data, vital status and Medicare data. Approximately 300,000 depressed patients and 300,000 non-depressed patients all without cardiovascular disease will be derived at baseline (i.e. fiscal years 1999-2000). Survival analyses will be used to compute the risk of incident heart disease and covariates will be modeled in a time dependent fashion. Objectives D-E will use data collected from diagnostic and qualitative interviews with 250 veterans. Structural equation modeling will be used to identify mediating and moderating pathways from depression to incident heart disease.
Not yet available.
5. Impact. We have established that depression and anxiety have as great an impact for cardiovascular disease as many established risk factors such as diabetes and hypertension. Closer monitoring of this high risk patient population may reduce morbidity and mortality in VA patients, and completion of a pharmacotherapy regimen for depression may reduce the risk for heart disease and mortality associated with this mental illness. Chronic opioid use is strongly associated with depression and may increase risk of depression. This association appears to raise risk of heart disease and warrants further investigation. Greater activity but not intensity should be emphasized when discussing lifestyle changes with patients who have a history of depression. More episodes of exercise, not caloric expenditure, appears to reduce risk of heart disease in depressed patients.
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- Scherrer JF, Grant JD, Duncan AE, Sartor CE, Haber JR, Jacob T, Bucholz KK. Subjective effects to cannabis are associated with use, abuse and dependence after adjusting for genetic and environmental influences. Drug and Alcohol Dependence. 2009 Nov 1; 105(1-2):76-82.
- Scherrer JF, Virgo KS, Zeringue A, Bucholz KK, Jacob T, Johnson RG, True WR, Carney RM, Freedland KE, Xian H, Caplan L, McDonald J, Eisen SA. Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis. General hospital psychiatry. 2009 Jul 1; 31(4):353-9.
- Scherrer JF, Xian H, Lyons MJ, Goldberg J, Eisen SA, True WR, Tsuang M, Bucholz KK, Koenen KC. Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence, and major depression in male twins. Comprehensive psychiatry. 2008 May 1; 49(3):297-304.
- Scherrer JF, Lustman P, Garfield L, Freedland K, Carney R, Chrusciel T, Zeringue A, Owen R, Bucholz K, True W. Depression is a Risk Factor for Incident Myocardial Infarction in Diabetic Patients. [Abstract]. Psychosomatic medicine. 2009 Apr 1.
Mental, Cognitive and Behavioral Disorders, Health Systems, Cardiovascular Disease
Epidemiology, Etiology, Pathology, Diagnosis, Treatment - Observational
Career Development, Depression