Depression is a Risk Factor for Coronary Artery Disease in Men
The Johns Hopkins precursors Study began in 1946, and includes data on 1190 men followed from the time of medical school graduation (mean age, 26), with a median duration of follow-up of 37 years. Information has been gathered by laboratory testing and mailed questionnaires. Self-reports of depression were confirmed by physician reviewers and had to conform to DSM criteria (Diagnostic and Statistical Manual of Mental Disorders).
At 40 years of follow-up, the cumulative incidence of depression was 12%, with no demonstrable clinically relevant differences in demographics among those who suffered depression and those who did not. Having clinical depression produced almost a doubling of risk for subsequent coronary heart disease, defined as MI, angina, chronic ischemic heart disease, or disorder requiring angioplasty or bypass surgery. The association between depression and heart disease was not explained by smoking, alcohol use, or coffee consumption. Depression was associated with greater risk of total mortality, and there was a trend toward increased cardiovascular disease mortality.
The authors conclude that their data, in concert with other studies, demonstrates that depression is an independent risk factor for coronary disease. Whether treatment of depression alters this association remains to be determined.
Ford DE, et al. Arch Intern Med 1998;158:1422-1426.
Clinical Scenario: The ECG shown in the figure was obtained from a 51-year-old man who was seen in the office a day following an episode of nausea and near syncope that occurred following physical exertion. The patient denied chest pain. He was previously healthy. He came to the office at the urging of his wife. In view of this history, how would you interpret this tracing? What would you advise the patient?
Interpretation: The rhythm is sinus and fairly regular at a rate of between 65 and 70 beats/min. All intervals are normal. The axis is approximately 0°. There is no evidence of chamber enlargement. The most remarkable finding on this tracing is the presence of inferior Q waves (that are deep and wide in leads III and aVF). In view of the above history (of an "episode" a day earlier, and suggestion by the spouse of patient denial)-there are several signs that should make you suspect possible recent (one day old) myocardial infarction. These include slight (residual) ST segment elevation in the leads with Q waves and subtle coving of the ST segment in leads III and aVF. Support that these findings are real and probably indicative of recent acute infarction is the presence of equally subtle ST segment depression (reciprocal changes) in leads I, aVL, V4, and, possibly, V5. The patient was urged to admit himself to the hospital. Cardiac enzymes confirmed a large acute infarction that was still in the process of evolving.
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