Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank
Objectives To assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes.Design Prospective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (70...
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e024433.full |
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| author | Daniel J Smith Daniel Mackay Nicholas Graham Joey Ward J P Pell Jonathan Cavanagh Sandosh Padmanabhan |
| author_facet | Daniel J Smith Daniel Mackay Nicholas Graham Joey Ward J P Pell Jonathan Cavanagh Sandosh Padmanabhan |
| author_sort | Daniel J Smith |
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| description | Objectives To assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes.Design Prospective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (702 902 person-years). Four mutually exclusive groups were compared: hypertension only (n=56 035), MDD only (n=15 098), comorbid hypertension plus MDD (n=12 929) and an unaffected (no hypertension, no MDD) comparison group (n=50 798).Setting UK Biobank.Participants UK Biobank participants without cardiovascular disease aged 39–70 who completed psychiatric questions relating International Classification of Diseases-10 Revision (ICD-10) diagnostic criteria on a touchscreen questionnaire at baseline interview in 2006–2010 (n=134 860).Primary and secondary outcome measures First-onset adverse cardiovascular outcomes leading to hospital admission or death (ICD-10 codes I20–I259, I60–69 and G45–G46), adjusted in a stepwise manner for sociodemographic, health and lifestyle features. Secondary analyses were performed looking specifically at stroke outcomes (ICD-10 codes I60–69 and G45–G46) and in gender-separated models.Results Relative to controls, adjusted HRs for adverse cardiovascular outcomes were increased for the hypertension only group (HR 1.36, 95% CI 1.22 to 1.52) and were higher still for the comorbid hypertension plus MDD group (HR 1.66, 95% CI 1.45 to 1.9). HRs for the comorbid hypertension plus MDD group were significantly raised compared with hypertension alone (HR 1.22, 95% CI 1.1 to 1.35). Interaction measured using relative excess risk due to interaction (RERI) and likelihood ratios (LRs) were identified at baseline (RERI 0.563, 95% CI 0.189 to 0.938; LR p=0.0116) but not maintained during the follow-up.Limitations Possible selection bias in UK Biobank and inability to assess for levels of medication adherence.Conclusions Comorbid hypertension and MDD conferred greater hazard than hypertension alone for adverse cardiovascular outcomes, although evidence of interaction between hypertension and MDD was inconsistent over time. Future cardiovascular risk prediction tools may benefit from the inclusion of questions about prior history of depressive disorders. |
| format | Article |
| id | doaj-art-8bcba44f46bb45c09c6c11dbcf2ebd59 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8bcba44f46bb45c09c6c11dbcf2ebd592025-08-20T01:52:50ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2018-024433Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK BiobankDaniel J Smith0Daniel Mackay1Nicholas Graham2Joey Ward3J P Pell4Jonathan Cavanagh5Sandosh Padmanabhan6Cardiff University School of Medicine, CardiffHealthy Working Lives Group, University of Glasgow, Glasgow, UK1 Gartnavel Royal Hopsital, University of Glasgow Institute of Health and Wellbeing, Glasgow, UKInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UKSchool of Health and Wellbeing, University of Glasgow, Glasgow, UK2 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UKUniversity of Glasgow, Glasgow, UKObjectives To assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes.Design Prospective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (702 902 person-years). Four mutually exclusive groups were compared: hypertension only (n=56 035), MDD only (n=15 098), comorbid hypertension plus MDD (n=12 929) and an unaffected (no hypertension, no MDD) comparison group (n=50 798).Setting UK Biobank.Participants UK Biobank participants without cardiovascular disease aged 39–70 who completed psychiatric questions relating International Classification of Diseases-10 Revision (ICD-10) diagnostic criteria on a touchscreen questionnaire at baseline interview in 2006–2010 (n=134 860).Primary and secondary outcome measures First-onset adverse cardiovascular outcomes leading to hospital admission or death (ICD-10 codes I20–I259, I60–69 and G45–G46), adjusted in a stepwise manner for sociodemographic, health and lifestyle features. Secondary analyses were performed looking specifically at stroke outcomes (ICD-10 codes I60–69 and G45–G46) and in gender-separated models.Results Relative to controls, adjusted HRs for adverse cardiovascular outcomes were increased for the hypertension only group (HR 1.36, 95% CI 1.22 to 1.52) and were higher still for the comorbid hypertension plus MDD group (HR 1.66, 95% CI 1.45 to 1.9). HRs for the comorbid hypertension plus MDD group were significantly raised compared with hypertension alone (HR 1.22, 95% CI 1.1 to 1.35). Interaction measured using relative excess risk due to interaction (RERI) and likelihood ratios (LRs) were identified at baseline (RERI 0.563, 95% CI 0.189 to 0.938; LR p=0.0116) but not maintained during the follow-up.Limitations Possible selection bias in UK Biobank and inability to assess for levels of medication adherence.Conclusions Comorbid hypertension and MDD conferred greater hazard than hypertension alone for adverse cardiovascular outcomes, although evidence of interaction between hypertension and MDD was inconsistent over time. Future cardiovascular risk prediction tools may benefit from the inclusion of questions about prior history of depressive disorders.https://bmjopen.bmj.com/content/9/9/e024433.full |
| spellingShingle | Daniel J Smith Daniel Mackay Nicholas Graham Joey Ward J P Pell Jonathan Cavanagh Sandosh Padmanabhan Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank BMJ Open |
| title | Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank |
| title_full | Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank |
| title_fullStr | Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank |
| title_full_unstemmed | Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank |
| title_short | Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank |
| title_sort | impact of major depression on cardiovascular outcomes for individuals with hypertension prospective survival analysis in uk biobank |
| url | https://bmjopen.bmj.com/content/9/9/e024433.full |
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