Depression and cardiovascular events among veterans

The study examined the association between depression and subsequent cardiovascular events and mortality among veterans enrolled at the VA Southern Nevada Healthcare System (VASNHS). Cardiovascular events under consideration included coronary artery disease, myocardial infarction, and stroke. The design was an age-matched case-control study to evaluate the presence of a prospective relationship between depression and cardiovascular events and mortality. Cases were defined as male veterans with a first diagnosis of a coronary artery disease, myocardial infarction, stroke, or death between January 2001 and August 2005. Controls were matched by age during the same Index Year. For coronary artery disease and myocardial infarction (CADMI) and death, a minimum of one control was randomly chosen for each case. This resulted in 343 cases and 356 controls for CADMI and 416 cases and 420 controls for death. Two controls were randomly selected for each stroke case yielding 71 cases and 142 controls. Ascertainment of depression, CADMI, stroke, death, and control variables was achieved through medical record review.; Greater percentages of comorbidities and positive family history of cardiovascular disease were seen among cases compared to controls for all three populations. Statistical analysis revealed that no predictive relationship was demonstrated between depression and coronary artery disease and myocardial infarction in bivariate (X2, 0.094, p=0.795), age-stratified (MH OR 1.04, 95% CI 0.738-1.454, p=0.839), or multivariate (OR 1.02, 95% CI 0.789-1.303, p=0.876) analyses. A positive association between depression and death was noted in bivariate (X2, 7.221, p=0.007) and age stratified analyses (MH OR 1.48, 95% CI 1.090-2.019, p=0.012), but the relationship became insignificant when adjusted in multivariate analysis (OR 1.16, 95% CI 0.935-1.434, p=0.178). Depression demonstrated a positive predictive relationship for stroke in bivariate (X2, 7.326, p=0.007), age-stratified (MH OR 1.48, 95% CI 1.090-2.019, p=0.012), and multivariate (OR 1.71, 95% CI 1.043-2.808, p=0.034) analyses. The study demonstrated a significant predictive relationship between depression and stroke, indicating that depressed patients should be screened for risk of stroke. Future studies with larger sample sizes and control groups should be performed to evaluate the relationship between depression and heart disease and depression and death.