Heartbeat: Coronary heart disease, obesity, smoking and long-lasting psychological distress

The importance of depression and psychological distress as a risk factor for coronary heart disease (CHD), is widely recognised, particularly in post-acute myocardial infarction patients. In this issue of Heart , Virtanen and colleagues1 report an original contribution to this field studying the long-term association of CHD and cardiovascular risk factors with levels of psychological distress over the patient’s lifetime, including symptoms of depression and anxiety. Using seven assessments of psychological distress over a 21-year follow-up of 6890 participants from the Whitehall II cohort study, the authors used group-based trajectory models (GBTM) to identify clusters of individuals (trajectory groups) with a similar trajectory over time (figure 1). The participants were grouped according to their trajectories as ‘persistently low’ (69% of the participants), ‘persistently intermediate’ (13%), ‘intermediate to low’ (12%), and ‘persistently high’ (7%) psychological distress. Prevalent CHD was associated with a approximately 1.9-fold, smoking with a 1.6-fold and obesity with a 1.5-fold likelihood of a persistently high psychological distress trajectory. After discussing the mechanisms related to this association, the authors concluded that ‘clinicians should be aware of the potential long-lasting associations of CHD, obesity and smoking as risk factors for prolonged psychological distress’. In the companion editorial, Barreto and Giatti2 stated that ‘expanding the knowledge on the long-term bidirectional …