Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity - PubMed (original) (raw)

Comparative Study

Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity

Kenneth S Kendler et al. Arch Gen Psychiatry. 2009 Aug.

Abstract

Context: Major depresssion (MD) and coronary artery disease (CAD) frequently co-occur. The mechanisms of comorbidity are uncertain.

Objective: To clarify sources of MD-CAD comorbidity.

Design: Major depression was assessed at the time of the personal interview, and CAD from hospital discharge records and death certificates.

Setting: Swedish population-based twin registry.

Participants: The study included 30 374 twins with a mean age of 57 years. Main Outcome Measure Modified DSM-IV diagnosis of MD or diagnosis of CAD.

Results: Lifetime association between MD and CAD was modest (odds ratio, approximately 1.3). In time-dependent Cox analyses, onset of CAD produced concurrent and ongoing hazard ratios for MD of 2.83 and 1.75. These risks increased if the diagnosis of CAD was restricted to myocardial infarction. Onset of MD increased the concurrent and ongoing hazard ratios for CAD to 2.53 and 1.17. The ongoing CAD risk was strongly associated with depressive severity and recurrence. Twin models showed that the modest comorbidity between MD and CAD in women arose primarily from shared genetic effects, although the genetic correlation was small (+0.16). In men, the source of comorbidity was moderated by age, being environmental in older members and largely genetic in younger members of the sample.

Conclusions: Although the MD-CAD relationship across the lifespan is modest, time-dependent models reveal stronger associations. The sustained effect of CAD onset on MD risk is much stronger than vice versa. The effect of MD on CAD is largely acute, and the longer-term effects are apparently mediated via depressive recurrence. When examined separately, in men, environmental effects, which are often acute, play a large role in MD-CAD comorbidity, whereas in women, chronic effects, which are in part genetic, are more important. In men, genetic sources of MD-CAD comorbidity are more important in younger members of the sample.

PubMed Disclaimer

Figures

Figure

Figure

Best-fit twin models for birth years 1930 and 1953. Parameter estimates from our best-fit twin model (model VI) for major depression (MD) and coronary artery disease (CAD) estimated for birth year 1930, which is 1 SD below the mean birth year in the sample (A) and for birth year 1953, which is 1 SD above the mean birth year in the sample (B). Omitted from the models is the estimated genetic correlation between MD and CAD in opposite-sex twins of +0.09. A indicates additive genetic effects; E, individual specific environmental effects; subscripts d and c, MD and CAD, respectively.

Similar articles

Cited by

References

    1. Bleuler E, Brill AA. Textbook of Psychiatry trans. New York, NY: Macmillan & Co; 1924.
    1. Malzberg B. Mortality among patients with involution melancholia. Am J Psychiatry. 1937;93:1231–1238.
    1. Carbone JR, Gorman JM, Goodman J, Willems MB. Mood disorders and the heart. In: Eaton WW, editor. Medical and Psychiatric Comorbidity Over the Course of Life. Washington, DC: American Psychiatric Publishing, Inc; 2006. pp. 97–127.
    1. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry. 1998;155(1):4–11. - PubMed
    1. Scherrer JF, Xian H, Bucholz KK, Eisen SA, Lyons MJ, Goldberg J, Tsuang M, True WR. A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosom Med. 2003;65(4):548–557. - PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources