Mental Disorders and Coronary Heart Disease Risk
Could the Evidence Elude Us While We Sleep?
Although provocative findings from large epidemiological studies suggest that mental disorders and elevated psychiatric symptoms are independent risk factors for the incidence and recurrence of coronary heart disease (CHD), other studies do not replicate this somewhat startling finding.1–3 This research has been characterized by incomplete adjustment for confounders, wide variation in the assessment of mental disorders, and inconsistent inclusion of multiple mental disorders and overlapping symptom clusters. For incident CHD, the most convincing evidence comes from prospective studies linking a diagnosis of depression or the presence of elevated depressive symptoms with later occult CHD.3 Although there have been tantalizing glimpses of associations of other types of mental disorders, such as alcohol/substance use disorder, anxiety, and schizophrenia, with incident CHD, there are a paucity of studies examining this risk. Indeed, we conducted a preliminary search of the prospective epidemiological literature on the association of mental disorders with incident CHD and found that, of 123 results retrieved, approximately 60% focused uniquely on depression, 10% on alcohol/substance use disorder, 11% on anxiety or posttraumatic stress disorder, and 14% on psychosis or schizophrenia. Thus, outstanding questions about the nature and consistency of the association of specific types of mental disorders—other than depression—and incident CHD remain.
Article see p 186
In this issue of Circulation, Gale et al4 provide results from a cohort of >1 million adult men born in Sweden from 1950 to 1976 who were followed for 22 years for incident CHD. Importantly, all were systematically assessed at conscription (approximately 18 years) for multiple psychiatric disorders by trained psychiatrists, including alcohol-related disorders, other nonaffective psychoses, schizophrenia, bipolar disorder, depressive disorders, neurotic disorders, adjustment disorders, personality disorders, and other substance use disorders. This is one of the first and largest population-based studies with such a comprehensive assessment of …