0
Editor's Correspondence |

Does Depression Specifically Increase Cardiovascular Mortality? In Reply

Sylvia Wassertheil-Smoller, PhD; Aaron Aragaki, MS; John Robbins, MD
Arch Intern Med. 2005;165(1):119-120. doi:10.1001/archinte.165.1.119-b.
Text Size: A A A
Published online

Extract

We thank Vinkers and colleagues for their comments about our article describing the association between depression and subsequent cardiovascular events.1 Vinkers et al raise the interesting question of whether the increased risk of cardiovascular mortality associated with depression may act through noncompliance with treatment on the part of those depressed rather than through a biological mechanism. We have no direct evidence on this issue because we have no measures of compliance. We know that the women participating in the study were not depressed to an extent that would impair their adherence to protocol, since that was an exclusion criterion, and we know that they complied with completing the annual forms and providing outcomes information about any hospitalizations. We also show that women with risk factors for cardiovascular disease, such as smoking, lack of physical activity, and being overweight, as well as women with hypertension, high cholesterol level, or diabetes, are more likely to be depressed at baseline. Therefore, we controlled for these factors. Because this was an observational study, the appropriate analysis of relative risks was through proportional hazards models, which control for multiple covariates that may be related both to being depressed and to the outcomes of interest, as well as for different follow-up times, rather than the crude relative risks presented in table by Vinkers and colleagues. Adjustment for confounding variables did not change the relationship between depression and cardiovascular mortality or all-cause mortality. We found no increase in cancer diagnosis or death associated with depression. Presumably, if noncompliance were the sole explanation, one might expect that there would be some relationship to cancer as well. It is most likely that biological mechanisms as well as compliance to treatment both are implicated in the mechanism of depression-associated cardiovascular mortality. It is a subject that deserves further study.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();