Physicians' Academy for Cardiovascular Education

Depression and exhaustion predict CVD mortality

Room for depressed and exhausted mood as a risk predictor for all cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men

Literature - Ladwig KH, Baumert J, Marten-Mittag B, et al. - Atherosclerosis 2017; published online ahead of print


There is still room for improvement in risk cardiovascular disease (CVD) prediction on top of the classical risk factors, because risk prediction in individuals with low and intermediate risks remains poor [1,2]. New potential CVD risk factors are depressed mood, excess fatigue and vital exhaustion, according to relevant studies and meta-analyses. For example, there are data showing an overall relative CVD risk of 1.60-1.90 for depressed mood subjects [3-5].

In this study, the predictive accuracy of traditional risk factors and depressed mood for all-cause mortality and fatal CVD endpoints was evaluated. In this prospective population-based study based on 3 independent WHO MONICA/KORA (Augsburg Germany) surveys conducted between 1984 and 1995 with a follow-up of 10 years, the absolute, relative and population-attributable risks (PARs) of depression and exhaustion (DEEX) were estimated, adjusted for hypertension, hypercholesterolemia, smoking, obesity and diabetes mellitus (DM).

Main results


DEEX predicts lower life expectancy and higher CVD mortality risk with an effect size comparable to traditional major risk factors. These findings underline the need for considering depression and exhaustion in a comprehensive screening and treatment strategy to prevent CVD, especially in subjects with an intermediate status of classical risk factors.


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