Combined Effects of Depressive Symptoms and Resting Heart Rate on Mortality: The Whitehall II Prospective Cohort Study
J Clin Psychiatry 2011;72(9):1199-1206
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Objective: To examine the combined effects of depressive symptoms and resting heart rate on mortality risk.
Method: Analysis was performed on data from 5,936 participants in the Whitehall II study with a mean ± SD age of 61 ± 6 years. Depressive symptoms were assessed from 2002 to 2004 using the Center for Epidemiologic Studies Depression Scale (cutoff score for depression at ≥ 16). Resting heart rate was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor groups on the basis of depression status (yes/no) and resting heart rate categories (< 60, 60–80, and > 80 beats/minute [bpm]). All-cause mortality was the main outcome in our analysis. Mean follow-up for mortality was 5.6 years.
Results: In mutually adjusted Cox regression models, depression (hazard ratio = 1.93, P < .001) and resting heart rate > 80 bpm (hazard ratio = 1.67, P < .001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high resting heart rate had a 3-fold higher (P < .001) risk of death compared to depression-free participants with resting heart rates ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent coronary heart disease.
Conclusions: This study provides evidence that the coexistence of depressive symptoms and elevated resting heart rate is associated with substantially increased risk of death compared to those without these 2 factors. This finding suggests the possibility that treatments that improve both depression and resting heart rate might improve survival.
J Clin Psychiatry
Submitted: December 10, 2009; accepted February 2, 2010.
Online ahead of print: December 14, 2010 (doi:10.4088/JCP.09m05901blu).
Corresponding author: Hermann Nabi, PhD, INSERM, U.1018, Center for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bâtiment 15/16, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France (Hermann.Nabi@inserm.fr).