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Association of Anxiety Disorders and Depression With Incident Heart Failure

Garfield, Lauren D. PhD, MPH; Scherrer, Jeffrey F. PhD; Hauptman, Paul J. MD; Freedland, Kenneth E. PhD; Chrusciel, Tim MPH; Balasubramanian, Sumitra MS; Carney, Robert M. PhD; Newcomer, John W. MD; Owen, Richard MD; Bucholz, Kathleen K. PhD; Lustman, Patrick J. PhD

doi: 10.1097/PSY.0000000000000027
Original Articles

Objective Depression has been associated with increased risk of heart failure (HF). Because anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence is associated with incident HF.

Methods A retrospective cohort (N = 236,079) including Veteran’s Administration patients (age, 50–80 years) free of cardiovascular disease (CVD) at baseline was followed up between 2001 and 2007. Cox proportional hazards models were computed to estimate the association between anxiety disorders alone, major depressive disorder (MDD) alone, and the combination of anxiety and MDD, with incident HF before and after adjusting for sociodemographics, CVD risk factors (Type 2 diabetes, hypertension, hyperlipidemia, obesity), nicotine dependence/personal history of tobacco use, substance use disorders (alcohol and illicit drug abuse/dependence), and psychotropic medication.

Results Compared with unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk for incident HF in age-adjusted models (hazard ratio [HR] = 1.19 [ 95% confidence interval {CI} = 1.10–1.28], HR = 1.21 [95% CI = 1.13–1.28], and HR = 1.24 [95% CI = 1.17–1.32], respectively). After controlling for psychotropics in a full model, the association between anxiety only, MDD only, and both disorders and incident HF increased (HRs = 1.46, 1.56, and 1.74, respectively).

Conclusions Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran’s Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications. Prospective studies are needed to clarify the role of depression and anxiety and their pharmacological treatment in the etiology of HF.

Supplemental digital content is available in the text.

From the Research Service (L.D.G., J.F.S., T.C., S.B.), Clinical Research and Epidemiology Workgroup, St Louis Veterans Affairs Medical Center, St Louis, Missouri; Department of Psychiatry (L.D.G., K.E.F., S.B., R.M.C., J.W.N., J.F.S., P.J.L., K.K.B.) and Midwest Alcoholism Research Center (K.K.B.), Washington University School of Medicine, St Louis, Missouri; Saint Louis University School of Medicine (J.F.S., P.J.H.), St Louis, Missouri; Charles E. Schmidt College of Medicine (J.W.N.), Florida Atlantic University, Boca Raton, Florida; HSR&D Center for Mental Healthcare and Outcomes Research (R.O.), Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Department of Epidemiology (R.O.), College of Public Health and Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas,

Address correspondence and reprint requests to Lauren D. Garfield, PhD, MPH, Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid Ave, St Louis, MO 63110. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received for publication August 4, 2012; revision received October 26, 2013.

Copyright © 2014 by American Psychosomatic Society
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