An attempt to explain the bidirectional association between ischaemic heart disease, stroke and depression: a cohort and meta-analytic approach
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Background: Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner. Aims: To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response. Method: A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017–2018. Exposures were physicians’ diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables. Results: IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43–2.23 and HR for stroke: 2.62, 95% CI 2.09–3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36–1.95) and stroke (HR = 1.94, 95% CI 1.63–2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders. Conclusions: The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.
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Baseline ischemic heart disease is associated with subsequent MDD (HR 1.79, 95% CI 1.43-2.23).
“On the other hand, baseline ischemic heart disease (HR: 1.79, 95% CI: 1.43-2.23) and stroke (HR: 2.62, 95% CI: 2.09-3.29) were associated with subsequent MDD, demonstrating a bidirectional relationship11.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [11]
The Results report that IHD was associated with subsequent depression after full adjustment, with exactly the stated HR and confidence interval. However, the Methods describe IHD diagnoses as a time-dependent exposure, so this estimate is not specifically for IHD present at baseline. (LLM, conf=0.84)
Experimental — accuracy not yet measuredBaseline stroke is associated with subsequent MDD (HR 2.62, 95% CI 2.09-3.29).
“On the other hand, baseline ischemic heart disease (HR: 1.79, 95% CI: 1.43-2.23) and stroke (HR: 2.62, 95% CI: 2.09-3.29) were associated with subsequent MDD, demonstrating a bidirectional relationship11.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [11]
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- Authors
- Wium-Andersen, M. K., Wium-Andersen, I. K., Prescott, E. I. B., Overvad, K., Jørgensen, M. B., & Osler, M.
- Affiliations
- Frederiksberg Hospital (DK)
- Aarhus University (DK)
- University of Copenhagen (DK)
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2019-06-10
- Volume
- 217
- Issue
- 2
- Pages
- 434-441
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2949770354
- Cited by
- 87
- References
- 29
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 16 · 2023: 7 · 2022: 12 · 2021: 11 · 2020: 10 · 2019: 2
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Hjerteforeningen
- Lundbeckfonden (R155-2013-14070, R231-2016-2550, 7-11-0213)
- TrygFonden (7‐11‐0213, R155-2013-14070)
- H. Lundbeck A/S
- 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
- depression, ischemic heart disease, stroke, bidirectional relationship, cardiovascular disease, shared risk factors, misclassification, nonresponse, antidepressants, chest pain, socioeconomic status, body mass index, statin use, serum lipids, Major Depression Inventory
- MeSH terms
- Depression, Female, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Proportional Hazards Models, Myocardial Ischemia, Stroke
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