Depression and Risk of Coronary Heart Disease in Elderly Men and Women

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Abstract
THERE IS mounting evidence that depression among patients with existing coronary heart disease (CHD) is associated with adverse outcomes, such as mortality and recurrent coronary events.1-7 Whether depression also constitutes a risk factor for incident CHD events is somewhat less clear. Although some studies8-10 have found no association between depression and incidence of CHD, the results of several recent studies11-15 suggest that depression may increase risk for incident CHD outcomes. However, few studies have examined the role of depression in predicting CHD in the elderly despite the steep increase in CHD incidence in old age, especially among women. In addition, standard risk factors often show inconsistent associations with CHD among the elderly and are therefore somewhat less useful to identify high-risk individuals than they are in middle age.16-18 Other risk factors, however, may become more important in older age. For example, results of recent studies19,20 suggest that impaired physical function poses a significant risk for CHD death and survival after myocardial infarction (MI) in the elderly. Because depressive symptoms are often a corollary of declining health and impaired function,21 it is important to investigate whether depression is associated with CHD outcomes independent of impaired physical function.