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Clinical Depression and Risk of Out-of-Hospital Cardiac Arrest
J. P. Empana, MD, PhD;
X. Jouven, MD, PhD;
R. N. Lemaitre, PhD, MPH;
N. Sotoodehnia, MD, MPH;
T. Rea, MD, MPH;
T. E. Raghunathan, PhD;
G. Simon, MD;
D. S. Siscovick, MD, MPH
Arch Intern Med. 2006;166:195-200.
Background The association of depression with coronary heart disease–related mortality has been widely recognized. This finding may partly reflect an association between depression and sudden death, in part because the imbalance between sympathetic and parasympathetic tone is altered in depressed subjects. We, thus, investigated whether the presence and severity of clinical depression was associated with a higher risk of sudden cardiac death.
Methods We used data from a population-based case-control study of risk factors for incident out-of-hospital cardiac arrest (CA) conducted among enrollees of a health maintenance organization in western Washington State. Cases (n = 2228) were aged 40 to 79 years and experienced CA between January 1, 1980, and December 31, 1994. Controls (n = 4164) were a stratified random sample of enrollees defined by calendar year, age, sex, and prior heart disease. Clinical depression was defined as physician diagnosis of depression or use of antidepressant treatment within the year before the event. Referral to mental health clinics or hospitalization for depression defined severe depression.
Results Clinically depressed patients had a higher odds ratio (OR) of CA (1.88; 95% confidence interval [CI], 1.59-2.23), which persisted after adjustment for confounders (OR, 1.43; 95% CI, 1.18-1.73). The association was observed in both sexes, in various age groups, and in subjects with prior physician-diagnosed heart disease (OR, 1.27; 95% CI, 1.01-1.60) and without prior physician-diagnosed heart disease (OR, 1.71; 95% CI, 1.22-2.41) (P = .13 for the interaction). Compared with nondepressed subjects, the risk of CA was increased in less severely depressed subjects (OR, 1.30; 95% CI, 1.04-1.63) and further increased in severely depressed subjects (OR, 1.77; 95% CI, 1.28-2.45) (P<.001 for trend).
Conclusion Clinical depression may be associated with a higher risk of CA independently of established coronary heart disease risk factors.
Author Affiliations: Sudden Death Epidemiology Unit, INSERM Avenir–U258, Hôpital Paul Brousse, Villejuif, France (Drs Empana and Jouven); Department of Cardiology, G. Pompidou European Hospital, Paris, France (Dr Jouven); Cardiovascular Health Research Unit (Drs Lemaitre, Sotoodehnia, Rea, Raghunathan, and Siscovick) and Departments of Medicine (Drs Lemaitre, Rea, and Siscovick), Cardiology (Dr Sotoodehnia), and Epidemiology (Dr Siscovick), University of Washington, Seattle; Institute for Social Research, University of Michigan, Ann Arbor (Dr Raghunathan); and Mental Health Clinic, Group Health Cooperative, Seattle (Dr Simon).
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