Key result
Current depressive symptoms linked to ~108% greater odds of CVD.
Why the study?
Despite high premature mortality from CVDs in Latvia, the association of depression and anxiety with cardiovascular morbidity in a primary care population was previously unexamined.
Are depression and anxiety associated with cardiovascular co-morbidity in a primary care population?
Cross-Sectional (n=1,565)
Yes
Are depression and anxiety associated with cardiovascular co-morbidity in a primary care population?
Odds Ratio: 2.08 (95% CI 1.3–3.32)
Absolute Event Rate: 25.4% vs 15.6%
p-value: p=0.002
Current and lifetime depressive episodes, but not anxiety, are significantly associated with increased cardiovascular morbidity in primary care patients.
Depressive symptoms link to CVD in primary care; hypothesis-generating and requires longitudinal confirmation before practice change.
BACKGROUND: Cardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population. METHODS: This cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression. RESULTS: From the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI). CONCLUSIONS: Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.
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Ivanovs et al. (2018) conducted a cross-sectional in Cardiovascular disease (n=1,565). Current depressive symptoms (PHQ-9 ≥ 10) vs. No current depressive symptoms was evaluated on Presence of cardiovascular disease (OR 2.08, 95% CI 1.30-3.32, p=0.002). Current depressive symptoms were significantly associated with increased odds of cardiovascular disease (OR 2.08) in a Latvian primary care population.
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