Positive Mental Attitude Associated With Lower Mortality After CVD Event

race and ethnicity impact CV health
race and ethnicity impact CV health
This longitudinal study assessed the effect on mortality of preexisting depression before a cardiovascular event.

Positive emotions and low levels of depression after a cardiovascular disease (CVD) event are associated with low risk for mortality during a 15-year period, according to study findings published in Depression and Anxiety.

A total of 6932 patients who were free from CVD and dementia were included in this study. Participants had completed the Center for Epidemiological Studies Depression (CES-D) scale every 4 to 5 years since 1993.

First incident CVD was experienced in 22% of participants during the 15-year follow-up period. After adjustment for physical function and smoking status, the researchers found that depression before CVD was not significantly associated with mortality (hazard ratio [HR] per 10-point score, 1.05; 95% CI, 0.99-1.10).

Participants who experienced their first incident CVD event also experienced an increase in depressive symptoms. According to the investigators, participants with high depressive symptoms after a CVD event had an increased risk for mortality during the follow-up period (HR, 1.13; 95% CI, 1.06-1.22).

Having higher post-CVD feelings of hopefulness, happiness, and enjoyment (positive affect) was associated with lower all-cause mortality (subdomain mutual adjustment HR, 0.92; 95% CI, 0.88-0.96; P <.001) and lower CVD mortality (subdomain mutual adjustment HR, 0.90; 95% CI, 0.84-0.95, P =.01), whereas higher somatic symptoms after a CVD event correlated with increased all-cause mortality risk mortality (subdomain mutual adjustment HR, 1.12; 95% CI, 1.04-1.21; P =.004).

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The investigators state that CV treatment, in addition to the severity of patients’ CVD, could have mediated the relationship between depression, CVD, and mortality. In addition, many patients did not return for assessment after their first incident CVD, further limiting the analysis.

Using subjective measures, such as self-report of physical function and depressive symptoms, may “provide valuable information in determining risk of mortality before the onset of CVD” in clinical practice.


Freak-Poli R, Ikram MA, Franco OH, Hofman A, Tiemeier H. Depressive symptoms prior to and after incident cardiovascular disease and long-term survival. A population-based study of older persons [published online November 24, 2017]. Depress Anxiety. doi: 10.1002/da.22689