Early-Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease
Open accessAbstract
Objectives The purpose of this study was to investigate the long-term cardiac effects of depression and anxiety assessed at a young age, when reverse causation is not feasible.Background Most prospective studies found a relatively strong association between depression and subsequent coronary heart disease (CHD). However, almost exclusively, only middle-age or older participants were examined, and subclinical atherosclerosis might contribute to the observed association. The prospective association between anxiety and CHD was less evident in previous studies and has been subjected to similar methodological concerns on the possibility for a reverse causation.Methods In a nationwide survey, 49,321 young Swedish men, 18 to 20 years of age, were medically examined for military service in 1969 and 1970. All the conscripts were seen by a psychologist for a structured interview. Conscripts reporting or presenting any psychiatric symptoms were seen by psychiatrists. Depression and anxiety was diagnosed according to International Classification of Diseases-8th Revision (ICD-8). Data on well-established CHD risk factors and potential confounders were also collected (i.e., anthropometrics, diabetes, blood pressure, smoking, alcohol consumption, physical activity, socioeconomic position, family history of CHD, and geographic area). Participants were followed for CHD and for acute myocardial infarction for 37 years.Results Multiadjusted hazard ratios associated with depression were 1.04 (95% confidence interval [CI]: 0.70 to 1.54), 1.03 (95% CI: 0.65 to 1.65), for CHD and for acute myocardial infarction, respectively. The corresponding multiadjusted hazard ratios for anxiety were 2.17 (95% CI: 1.28 to 3.67) and 2.51 (95% CI: 1.38 to 4.55).Conclusions In men, aged 18 to 20 years, anxiety as diagnosed by experts according to ICD-8 criteria independently predicted subsequent CHD events. In contrast, we found no support for such an effect concerning early-onset depression in men.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Anxiety disorders are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality.
“In addition to the profound negative impact on individuals’ wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality.”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [12]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Inflammation, Atherosclerosis, and Coronary Artery Disease
Hansson, G. K. (2005) · New England Journal of Medicine · doi:10.1056/nejmra043430 · Cited by 8,773 · see citing works
Childhood and adolescent depression: a review of the past 10 years, Part I
BIRMAHER, B., RYAN, N. D., WILLIAMSON, D. E., BRENT, D. A., KAUFMAN, J., DAHL, R. E., PEREL, J., & NELSON, B. (1996) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199611000-00011 · Cited by 2,076 · see citing works
'Vascular Depression' Hypothesis
Alexopoulos, G. S. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830220033006 · Cited by 1,843 · see citing works
Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J. A. (1993) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.102.1.133 · Cited by 1,547 · see citing works
Nicholson, A., Kuper, H., & Hemingway, H. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl338 · Cited by 1,353 · see citing works
Hemingway, H., & Marmot, M. G. (1999) · BMJ · doi:10.1136/bmj.318.7196.1460 · Cited by 1,342 · see citing works
Risk for recurrence in depression
Burcusa, S. L., & Iacono, W. G. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.02.005 · Cited by 1,023 · see citing works
Mortality of patients with mood disorders: follow-up over 34–38 years
Angst, F., Stassen, H. H., Clayton, P. J., & Angst, J. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00377-9 · Cited by 881 · see citing works
Multiple recurrences of major depressive disorder
Solomon, D. A., Keller, M. B., Leon, A. C., Mueller, T. I., Lavori, P. W., Shea, M. T., Coryell, W., Warshaw, M., Turvey, C., Maser, J. D., et al. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.2.229 · Cited by 835 · see citing works
Wulsin, L. R., & Singal, B. M. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000058371.50240.e3 · Cited by 730 · see citing works
Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study.
Kawachi, I. I., Sparrow, D., Vokonas, P., & Weiss, S. T. (1994) · Circulation · doi:10.1161/01.cir.90.5.2225 · Cited by 618 · see citing works
Epidemiology of comorbid coronary artery disease and depression
Rudisch, B. E., & Nemeroff, C. B. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00587-0 · Cited by 549 · see citing works
Zammit, S., Allebeck, P., David, A. S., Dalman, C., Hemmingsson, T., Lundberg, I., & Lewis, G. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.4.354 · Cited by 471 · see citing works
Self-citationKOVACS, M. (1996) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199606000-00010 · Cited by 441 · see citing works
Kuper, H., Marmot, M., & Hemingway, H. (2002) · Seminars in Vascular Medicine · doi:10.1055/s-2002-35401 · Cited by 415 · see citing works
Depression, mortality, and medical morbidity in patients with coronary heart disease
Carney, R. M., & Freedland, K. E. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00111-2 · Cited by 378 · see citing works
Psychosocial factors in the development of coronary artery disease
Strike, P. C., & Steptoe, A. (2004) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2003.09.001 · Cited by 316 · see citing works
Depression and vascular disease: what is the relationship?
Thomas, A. J. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00349-x · Cited by 267 · see citing works
Reflections on Depression as a Cardiac Risk Factor
Frasure‐Smith, N., & Lespérance, F. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000162253.07959.db · Cited by 258 · see citing works
Penninx, B. W. J. H., Guralnik, J. M., de Leon, C. F. M., Pahor, M., Visser, M., Corti, M., & Wallace, R. B. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00077-0 · Cited by 205 · see citing works
Depression as a risk factor for ischaemic heart disease in men: population based case-control study
Hippisley‐Cox, J., Fielding, K., & Pringle, M. (1998) · BMJ · doi:10.1136/bmj.316.7146.1714 · Cited by 203 · see citing works
de Leon, C. F. M., Krumholz, H. M., Seeman, T. S., Vaccarino, V., Williams, C. S., Kasl, S. V., & Berkman, L. F. (1998) · PubMed · doi:10.1001/archinte.158.21.2341 · Cited by 201 · see citing works
Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men
Shen, B., Avivi, Y. E., Todaro, J. F., Spiro, A., Laurenceau, J., Ward, K. D., & NIAURA, R. S. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.09.033 · Cited by 150 · see citing works
Janszky, I., Lekander, M., Blom, M., Georgiades, A., & Ahnve, S. (2005) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2005.01.001 · Cited by 149 · see citing works
Self-citationNational Health Data Registers: a Nordic heritage to public health
Rosén, M. (2002) · Scandinavian Journal of Public Health · doi:10.1177/14034948020300020101 · Cited by 134 · see citing works
Cardiovascular death and manic-depressive psychosis
Weeke, A. (1987) · Journal of Affective Disorders · doi:10.1016/0165-0327(87)90049-8 · Cited by 128 · see citing works
Anger and anxiety in borderline hypertension.
Schneider, R. H., Egan, B. M., Johnson, E. H., Drobny, H., & Julius, S. (1986) · Psychosomatic Medicine · doi:10.1097/00006842-198603000-00009 · Cited by 127 · see citing works
Power spectrum analysis and cardiovascular morbidity in anxiety disorders
Cohen, H., & Benjamin, J. (2006) · Autonomic Neuroscience · doi:10.1016/j.autneu.2005.06.007 · Cited by 114 · see citing works
Medical comorbidity and late life depression: what is known and what are the unmet needs?
Charlson, M. E., & Peterson, J. C. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01422-1 · Cited by 106 · see citing works
Paterniti, S., Alpérovitch, A., Ducimetière, P., Dealberto, M.-J., Lépine, J., & Bisserbe, J. C. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199901000-00013 · Cited by 93 · see citing works
Task Force #1—magnitude of the prevention problem: opportunities and challenges
Benjamin, E. J., Smith, S. C., Cooper, R., Hill, M. N., & Luepker, R. V. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02082-x · Cited by 78 · see citing works
Romelsjö, A., & Leifman, A. (1999) · BMJ · doi:10.1136/bmj.319.7213.821 · Cited by 72 · see citing works
Anxiety and outcome expectations predict the white-coat effect
Jhalani, J., Goyal, T., Clemow, L., Schwartz, J. E., Pickering, T. G., & Gerin, W. (2005) · Blood Pressure Monitoring · doi:10.1097/00126097-200512000-00006 · Cited by 67 · see citing works
Hemmingsson, T., & Lundberg, I. (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh314 · Cited by 65 · see citing works
Self-citationFalkstedt, D., Koupil, I., & Hemmingsson, T. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e3282ffb17e · Cited by 58 · see citing works
Self-citationJanszky, I., Ahlbom, A., Hallqvist, J., & Ahnve, S. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.08.039 · Cited by 56 · see citing works
Self-citationPrevalence of mental disorder in an urban population in central Sweden
Halldin, J. (1984) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1984.tb02525.x · Cited by 47 · see citing works
Kessing, L. V. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80700-7 · Cited by 47 · see citing works
Male youths. A sociopsychiatric study of a total annual population of Swedish adolescent boys.
Otto, U. (1976) · PubMed · Cited by 47 · see citing works
Generalized anxiety disorder : symptomatology, pathogenesis and management
Nutt, D., Rickels, K., & Stein, D. J. (2002) · Martin Dunitz eBooks · Cited by 34 · see citing works
Is there an association between depression and cardiovascular mortality or sudden death?
Alboni, P., Favaron, E., Paparella, N., Sciammarella, M., & Pedaci, M. (2008) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e3282785240 · Cited by 29 · see citing works
Triggers and the Onset of Acute Myocardial Infarction
Hammoudeh, A. J., & Alhaddad, I. A. (2009) · Cardiology in Review · doi:10.1097/crd.0b013e3181bdba75 · Cited by 25 · see citing works
Longitudinal population-based studies of affective disorders: Where to from here?
Beard, J., Galea, S., & Vlahov, D. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-83 · Cited by 21 · see citing works
Suicide and Depression in the Male Part of the Lundby Study
Hagnell, O., Lanke, J., & Rorsman, B. (2008) · Neuropsychobiology · doi:10.1159/000117897 · Cited by 20 · see citing works
Association Between White-Coat Effect and Blunted Dipping of Nocturnal Blood Pressure
Bochud, M., Bovet, P., Vollenweider, P., Maillard, M. P., Paccaud, F. M., Wandeler, G., Gabriel, A., & Burnier, M. (2009) · American Journal of Hypertension · doi:10.1038/ajh.2009.133 · Cited by 18 · see citing works
Psychological factors affecting cardiologic conditions.
Rafanelli, C., Roncuzzi, R., Ottolini, F., & Rigatelli, M. (2007) · Advances in Psychosomatic Medicine · doi:10.1159/000106798 · Cited by 13 · see citing works
Flagged first, then by citations
Research works printed but not linked: 5
- Janszky et al. JACC Vol. 56, No. 1, 2010 Early-Onset Depression, Anxiety, and Risk of Coronary Disease June 29, 2010:31-7
- Ahlborg B, Linroth K, Nordgren B, Schéle R. Ett hälso-och kapa- citetsundersökningssystem för personalselektion. Swedish J Defence Med 1973;9:36 -52.
- WHO. Glossary of Mental Disorders and Guide to Their Classifica- tion, for Use in Conjunction With the International Classification of Diseases, Eighth Edition. Geneva: World Health Organization, 1974.
- Penninx BW, Guralnik JM, Mendes de Leon CF, et al. Cardiovascular events and mortality in newly and chronically depressed persons Ͼ70 years of age. Am J Cardiol 1998;81:988 -94.
- Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. Phila- delphia, PA: Lippincott Williams & Wilkins, 2008.
Cited by
Sorted by citations
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., et al. (2017) · World Psychiatry · doi:10.1002/wps.20420 · Cited by 1,729 · see citing works
Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis
Chalmers, J. A., Quintana, D. S., Abbott, M. J.-A., & Kemp, A. H. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00080 · Cited by 1,067 · see citing works
“To date, no meta-analysis has been published on HRV and the anxiety disorders; this is a surprising observation considering that anxiety is an early marker of cardiovascular risk and a robust predictor of CVD and sudden cardiac death, independent of demographic risk factors, biological risk factors, and health behavio…”
BackgroundState of the art review: depression, stress, anxiety, and cardiovascular disease
Cohen, B. E., Edmondson, D., & Kronish, I. M. (2015) · American Journal of Hypertension · doi:10.1093/ajh/hpv047 · Cited by 955 · see citing works
Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies
Gan, Y., Gong, Y., Tong, X., Sun, H., Cong, Y., Dong, X., Wang, Y., Xu, X., Yin, X., Deng, J., et al. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0371-z · Cited by 502 · see citing works
Insomnia and the Risk of Acute Myocardial Infarction: A Population Study
Laugsand, L. E., Vatten, L. J., Platou, C., & Janszky, I. (2011) · Circulation · doi:10.1161/circulationaha.111.025858 · Cited by 438 · see citing works
Self-citationHeartache and heartbreak—the link between depression and cardiovascular disease
Nemeroff, C. B., & Goldschmidt-Clermont, P. J. (2012) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2012.91 · Cited by 424 · see citing works
Exercise as Treatment for Anxiety: Systematic Review and Analysis
Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9685-9 · Cited by 363 · see citing works
Anxiety and new onset of cardiovascular disease: critical review and meta-analysis
Batelaan, N. M., Seldenrijk, A., Bot, M., van Balkom, A. J. L. M., & Penninx, B. W. J. H. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.156554 · Cited by 362 · see citing works
Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease
Emdin, C. A., Odutayo, A., Wong, C. X., Tran, J., Hsiao, A. J., & Hunn, B. H. M. (2016) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.05.041 · Cited by 329 · see citing works
Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety
Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0923-x · Cited by 291 · see citing works
Psychosocial stress and cardiovascular disease
Dar, T., Radfar, A., Abohashem, S., Pitman, R. K., Tawakol, A., & Osborne, M. T. (2019) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-019-0724-5 · Cited by 248 · see citing works
Anxiety and cardiovascular disease risk: a review
Tully, P. J., Harrison, N. J., Cheung, P., & Cosh, S. (2016) · Current Cardiology Reports · doi:10.1007/s11886-016-0800-3 · Cited by 211 · see citing works
Lazzarino, A. I., Hamer, M., Stamatakis, E., & Steptoe, A. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182898e6d · Cited by 140 · see citing works
Kandola, A., & Stubbs, B. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-15-1792-1_23 · Cited by 140 · see citing works
Psychopharmacology and Cardiovascular Disease
Piña, I. L., Di Palo, K. E., & Ventura, H. O. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.458 · Cited by 126 · see citing works
Chalmers, J. A., Heathers, J. A. J., Abbott, M. J., Kemp, A. H., & Quintana, D. S. (2016) · BMC Psychology · doi:10.1186/s40359-016-0138-z · Cited by 102 · see citing works
Cardiac Rehabilitation in the Elderly
Menezes, A. R., Lavie, C. J., Forman, D. E., Arena, R., Milani, R. V., & Franklin, B. A. (2014) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2014.01.002 · Cited by 88 · see citing works
Van Beek, M. H. C. T., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J. L. M., Speckens, A. E. M., & Oude Voshaar, R. C. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.174870 · Cited by 76 · see citing works
For the Israel Study Group on First Acute Myocardial Infarction, Benyamini, Y., Roziner, I., Goldbourt, U., Drory, Y., & Gerber, Y. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9509-3 · Cited by 65 · see citing works
Wingo, A. P., & Gibson, G. (2015) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2014.09.016 · Cited by 59 · see citing works
Mental disorders as risk factors: assessing the evidence for the global burden of disease study
Baxter, A. J., Charlson, F. J., Somerville, A. J., & Whiteford, H. A. (2011) · BMC Medicine · doi:10.1186/1741-7015-9-134 · Cited by 58 · see citing works
Carotid atherosclerosis in depression and anxiety: Associations for age of depression onset
Seldenrijk, A., van Hout, H. P. J., van Marwijk, H. W. J., de Groot, E., Gort, J., Rustemeijer, C., Diamant, M., & Penninx, B. W. J. H. (2011) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2011.583942 · Cited by 35 · see citing works
Association of anxiety with resistance vessel dysfunction in human atherosclerosis
Stillman, A. N., Moser, D. J., Fiedorowicz, J., Robinson, H. M., & Haynes, W. G. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31829a0ae3 · Cited by 29 · see citing works
Fear and distress disorders as predictors of heart disease: a temporal perspective
Roest, A. M., de Jonge, P., Lim, C. W. W., Stein, D. J., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.03.015 · Cited by 22 · see citing works
- Authors
- Janszky, I., Ahnve, S., Lundberg, I., & Hemmingsson, T.
- Affiliations
- Karolinska Institutet (SE)
- Uppsala University (SE)
- Corresponding author
- Janszky, Imre
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 56
- Issue
- 1
- Pages
- 31-37
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W117227024
- Cited by
- 260
- References
- 47
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 16 · 2023: 7 · 2022: 14 · 2021: 21 · 2020: 18 · 2019: 9 · 2018: 18 · 2017: 12 · 2016: 22 · 2015: 18 · 2014: 17 · 2013: 26 · 2012: 19
- FWCI
- 15.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Swedish Council of Working Life and Social Research
- Ansgarius Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- early-onset depression, anxiety, coronary artery disease, acute myocardial infarction, young men, conscripts, long-term cardiovascular risk, psychiatric symptoms, reverse causality
- MeSH terms
- Adolescent, Anxiety Disorders, Coronary Disease, Depression, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Registries, Risk Factors, Sweden, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
