Objective: To compare patients with and without major depression with respect to their rates of transition to several stages of cardiovascular disease progression.
Study design: Retrospective observational study.
Methods: The study used administrative data from a large insurer in Hawaii to evaluate associations of major depression with cardiovascular progression. Analyses used competing-risks models, models that allow more than 1 type of possible outcome event at the transition stages. All analyses were adjusted for age and sex.
Results: Among nearly 600,000 healthy members, those with major depression in the past year were 50% to 100% more likely than controls to develop hypertension or dyslipidemia. Rates were increased to a similar magnitude (1) among patients with hypertension or dyslipidemia who subsequently developed either the other condition or coronary artery disease and (2) among patients with hypertension and dyslipidemia who developed coronary artery disease or congestive heart failure. Transition rates to coronary artery disease or congestive heart failure also were increased 50% to 100% among patients with diabetes, hypertension, and dyslipidemia. The sequence of associations remained as strong examining depression 1-2 years in the past as with depression in the past year.
Conclusions: The results show a pattern of faster transitions for patients with major depression compared with patients without major depression across both the early and later stages of cardiovascular progression. Health plans offer a setting where patients with depression can be identified and where interventions might be undertaken to minimize the possible effects of depression on transition rates.