Symptoms of anxiety and depression as precursors for future acute myocardial infarction (AMI)- The HUNT study

Introduction. We aimed to study the association of symptoms of anxiety, depression and mixed anxiety and depression in healthy men and women with risk for future acute myocardial infarction (AMI). Methods. A total of 63014 individuals who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-97) were followed up to 2008 for a first AMI. Participants self- reported symptoms on the Hospital Anxiety and Depression Scale (HADS) prospectively. Incident AMI was identified at two county hospitals or by the National Cause of Death Registry. Results. During 11.4 years of follow up time 2838 incidents of AMIs occurred. In an age adjusted Cox regression model, a moderate increase in the AMI hazard among women with symptoms of depression (1.27, 95% CI 1.08-1.5) and mixed anxiety and depression (1.22, 95% CI 1.04-1.42), but not for anxiety (1.12, 95% CI 0.95-1.32). For men the estimates for depression were 1.00 (95% CI 0.86-1.15), anxiety 0.99 (95% CI 0.84-1.18) and for mixed anxiety and depression 0.99 (95% CI 0.85-1.14). The risks did not change for additional adjustments for marital status, education and work status. After adjustment for lifestyle factors, including current smoking, diabetes and cholesterol, the estimate for depression in women was 1.13 (95% CI 0.90-1.40). Conclusion There was a significant increase in the hazards for AMI in women, but not in men related to symptoms of depression and mixed depression and anxiety. However, lifestyle factors appeared to explain the association to a large extent.