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OBJECTIVETo investigate major depressive disorder (MDD), which complicates the course of type 2 diabetes and is associated with an increased risk of cardiovascular disease and death. This risk may be due to a greater susceptibility for myocardial infarction (MI) in depressed patients with type 2 diabetes compared with nondepressed patients with type 2 diabetes.RESEARCH DESIGN AND METHODSVeterans Administration electronic medical records were analyzed to identify a cohort free of cardiovascular disease in fiscal years 1999 and 2000, aged 25 to 80 years. ICD-9-CM codes were used to create a four-level risk group indicating 1) neither diabetes nor MDD (n = 214,749), 2) MDD alone (n = 77,568), 3) type 2 diabetes alone (n = 40,953), and 4) comorbid MDD and type 2 diabetes (n = 12,679). Age-adjusted Cox proportional hazards models were computed before and after adjusting for baseline sociodemographic and time-dependent covariates.RESULTSAfter adjusting for covariates, patients with type 2 diabetes alone and patients with MDD alone were at ∼30% increased risk for MI, and patients with type 2 diabetes and MDD were at 82% increased risk for MI (hazard ratio 1.82 [95% CI 1.69–1.97]) compared with patients without either condition.CONCLUSIONSCompared with patients with only diabetes or only MDD, individuals with type 2 diabetes and MDD are at increased risk for new-onset MI. Monitoring cardiovascular health in depressed patients with type 2 diabetes may reduce the risk of MI in this especially high-risk group.

Objective Depression has been associated with increased risk of heart failure (HF). Since anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence are associated with incident HF. Methods A retrospective cohort (n=236,079) including VA patients (ages 50–80), free of cardiovascular disease (CVD) at baseline, was followed 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 to unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk of incident HF in age-adjusted models (HR=1.19, 95% C.I., 1.10–1.28; HR=1.21 95%C.I., 1.13–1.28; HR=1.24, 95%C.I., 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 VA 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.