Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis

Abstract Objective This study evaluates whether depression is a risk factor for incident myocardial infarction (MI) in Department of Veterans Affairs (VA) patients with rheumatoid arthritis (RA) between 30 and 79 years of age. Methods We used a retrospective cohort study of 15,634 patients with RA....

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Bibliographic Details
Published in:General hospital psychiatry 2009-07, Vol.31 (4), p.353-359
Main Authors: Scherrer, Jeffrey F., Ph.D, Virgo, Katherine S., Ph.D, Zeringue, Angelique, M.S, Bucholz, Kathleen K., Ph.D, Jacob, Theodore, Ph.D, Johnson, Robert G., M.D, True, William R., Ph.D., M.P.H, Carney, Robert M., Ph.D, Freedland, Kenneth E., Ph.D, Xian, Hong, Ph.D, Caplan, Liron, M.D, McDonald, Jay, M.D, Eisen, Seth A., M.D
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Aged
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - diagnosis
Arthritis, Rheumatoid - drug therapy
Biological and medical sciences
Cardiology. Vascular system
Comorbidity
Coronary heart disease
Depression
Depressive Disorder - complications
Depressive Disorder - diagnosis
Diseases of the osteoarticular system
Female
Follow-Up Studies
Heart
Humans
Incidence
Inflammation
Inflammatory joint diseases
Male
Medical sciences
Middle Aged
Mood disorders
Multivariate Analysis
Myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - epidemiology
Myocardial Infarction - etiology
Myocarditis. Cardiomyopathies
Population Surveillance
Proportional Hazards Models
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Retrospective Studies
Rheumatoid arthritis
Risk Factors
Severity of Illness Index
Socioeconomic Factors
United States
United States Department of Veterans Affairs
Veterans
Veterans - statistics & numerical data
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Summary:Abstract Objective This study evaluates whether depression is a risk factor for incident myocardial infarction (MI) in Department of Veterans Affairs (VA) patients with rheumatoid arthritis (RA) between 30 and 79 years of age. Methods We used a retrospective cohort study of 15,634 patients with RA. Diagnoses and sociodemographic data were obtained from VA administrative and pharmacy databases between fiscal years 1999 and 2006. Entry into the cohort required 2 years of patient time with no evidence of cardiovascular disease. Cox proportional hazard models with time-dependent covariates were computed to determine whether RA patients with depression as compared to RA patients without depression were at increased risk for MI during the maximum 6-year follow-up period. Results Unadjusted analyses indicated depressed RA patients were 1.4 times more likely than nondepressed RA patients to have an MI during follow-up. These results remained significant (HR=1.4; 95% CI: 1.1–1.8) in the adjusted Cox proportional hazards model which included the effects of sociodemographics and known physical risks (e.g., diabetes) for MI. Conclusions Depressed RA patients, without a history of cardiovascular disease, are 40% more likely to have a heart attack as compared to those without depression. These data demonstrate a rapid (within 6 years) transition to MI following onset of depression in RA patients. Increased monitoring of depression and heart disease status in this patient population may be warranted which in turn may result in longer duration of life.
ISSN:0163-8343
1873-7714
DOI:10.1016/j.genhosppsych.2009.04.001