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MI risk high in depressed patients with diabetes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with depression or diabetes have an increased risk of MI, but the risk is even higher in patients with both conditions, according to a new study reported in Diabetes Care online June 16.

“Collaborative care models that incorporate cardiology, mental health, and primary care may improve outcomes in this complex patient population,” the authors suggest.

Evidence indicates that depression worsens cardiovascular outcomes in type 2 diabetes, but no study has looked at specific endpoints such as MI, explain Dr. Jeffrey F. Scherrer, with the St. Louis Veterans Affairs Medical Center and Washington University School of Medicine in St. Louis, Missouri, and colleagues.

To “fill this gap in the literature,” the team examined Veterans Administration data to identify over half a million patients who were free of cardiovascular disease in 1999 and 2000.

This cohort included 214,749 individuals without diabetes or major depressive disorder (MDD), 77,568 with MDD alone, 40,953 with type 2 diabetes only, and 12,679 with comorbid MDD and type 2 diabetes, according to the report. During 7 years’ follow-up, incident MI rates in the four groups were 2.6%, 3.5%, 5.9%, and 7.4%, respectively.

With the non-MDD non-diabetes group as referent, multivariate-adjusted hazard ratios for MI were 1.29 for those with depression only, 1.33 for those with diabetes only, and 1.82 among patients with both conditions, the investigators found.

“The current study confirms that MDD is associated with a greater hazard of incident MI in patients with type 2 diabetes,” Dr. Scherrer and colleagues conclude.

“Patients may benefit from first receiving cognitive behavior therapy or other nonpharmacologic treatment if antidepressants increase the risk for further cardiovascular disease such as heart failure,” they suggest.

Reference:
Increased Risk of Myocardial Infarction in Depressed Patients With Type 2 Diabetes
Diabetes Care 2011.