Somatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.

We confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.

This study found that anxiety disorders predicted shorter telomere length at follow-up in a general population cohort. The association was not explained by adverse life events, lifestyle factors, educational level and antidepressant use. How anxiety disorders might lead to accelerated telomere shortening and whether this might be a mediator explaining the excess mortality risk associated with anxiety deserve further investigation.

Objective Shortened telomere length has been associated with mortality in patients with coronary heart disease (CHD) and is considered an emerging marker of biological age. Whether depression is associated with telomere length or trajectory has not been evaluated in patients with CHD. Methods In a prospective cohort study, we measured leukocyte telomere length in 952 participants with stable CHD at baseline and in 608 of these participants after 5 years of follow up. Presence of major depressive disorder (MDD) in the past month was assessed using the computerized Diagnostic Interview Schedule (CDIS-IV) at baseline. We used linear and logistic regression models to evaluate the association of depression with baseline and 5-year change in leukocyte telomere length. Results Of the 952 participants, 206 (22%) had major depression at baseline. After adjustment for age and sex, patients with current major depressive disorder had shorter baseline telomere length than those without depression (mean ± SE: 0.86±0.02 vs. 0.90±0.01, P= 0.02). This association was similar (but no longer statistically significant) after adjustment for body mass index, smoking, diabetes, left ventricular ejection fraction, statin use, antidepressant use, physical inactivity, and anxiety (0.85±0.02 vs. 0.89±0.01, P= 0.06). Depression was not predictive of 5-year change in telomere length after adjustment for the above covariates and baseline telomere length. Conclusions Depression is associated with reduced leukocyte telomere length in patients with coronary heart disease but does not predict 5-year change in telomere length. Future research is necessary to elucidate the potential mechanisms underlying the association between depression and telomere length.