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The Precursors Study

Daniel E. Ford, MD, MPH; Lucy A. Mead, ScM; Patricia P. Chang, MD; Lisa Cooper-Patrick, MD, MPH; Nae-Yuh Wang, MS; Michael J. Klag, MD, MPH

Arch Intern Med. 1998;158:1422-1426.

Background  Several studies have found that depression is an independent predictor of poor outcome after the onset of clinical coronary artery disease. There are few data concerning depression as a risk factor for the development of coronary artery disease.

Objective  To determine if clinical depression is an independent risk factor for incident coronary artery disease.

Patients and Methods  The Johns Hopkins Precursors Study is a prospective, observational study of 1190 male medical students who were enrolled between 1948 and 1964 and who continued to be followed up. In medical school and through the follow-up period, information was collected on family history, health behaviors, and clinical depression. Cardiovascular disease end points have been assessed with reviews of annual questionnaires, National Death Index searches, medical records, death certificates, and autopsy reports.

Results  The cumulative incidence of clinical depression in the medical students at 40 years of follow-up was 12%. Men who developed clinical depression drank more coffee than those who did not but did not differ in terms of baseline blood pressure, serum cholesterol levels, smoking status, physical activity, obesity, or family history of coronary artery disease. In multivariate analysis, the men who reported clinical depression were at significantly greater risk for subsequent coronary heart disease (relative risk [RR], 2.12; 95% confidence interval [CI], 1.24-3.63) and myocardial infarction (RR, 2.12; 95% CI, 1.11-4.06). The increased risk associated with clinical depression was present even for myocardial infarctions occurring 10 years after the onset of the first depressive episode (RR, 2.1; 95% CI, 1.1-4.0).

Conclusion  Clinical depression appears to be an independent risk factor for incident coronary artery disease for several decades after the onset of the clinical depression.

From the Department of Medicine, The Johns Hopkins University School of Medicine (Drs Ford, Chang, Cooper-Patrick, and Klag and Ms Mead); the Departments of Biostatistics (Mr Wang), Epidemiology (Drs Ford and Klag), and Health Policy and Management (Drs Ford, Cooper-Patrick, and Klag), The Johns Hopkins University School of Hygiene and Public Health; and Welch Center for Prevention, Epidemiology, and Clinical Research (Drs Ford, Cooper-Patrick, and Klag and Ms Mead), Baltimore, Md.

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