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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

  • Karl-Heinz Ladwig
    Correspondence
    Corresponding author. Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany

    Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Jens Baumert
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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  • Birgitt Marten-Mittag
    Affiliations
    Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Karoline Lukaschek
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Department of Psychosomatic Medicine and Psychotherapy, University of Marburg and Gießen, Germany
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  • Hamimatunnisa Johar
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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  • Xioayan Fang
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Joram Ronel
    Affiliations
    Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Christa Meisinger
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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  • Annette Peters
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany
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  • for theKORA Investigators

      Highlights

      • The adjusted depressed mood and exhaustion (DEXX) hazard ratio of 1.52 for cardiovascular disease (CVD) mortality is comparable to hypercholesterolemia and obesity but lower than for hypertension, smoking and diabetes.
      • Adjusted 15%-PARs for CVD mortality give DEEX a concise middle ranking in relation to hypercholesterolemia, obesity and smoking (ranging from 8.4% to 21.4%).
      • The improvement in risk prediction for DEEX is comparable to obesity and hyper-cholesterolemia and in consequence may serve the same purpose.

      Abstract

      Background and aims

      Depressed mood and exhaustion (DEEX) have gained attention as a risk predictor for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse.

      Methods

      The study included 3428 men aged 45–74 years who participated in one of three population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (31,791 person-years), 557 cases of all-cause mortality and 269 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification improvement.

      Results

      The (crude) absolute mortality risk for DEEX was 23.1 cases per 1000 person-years for all-cause and 11.2 for CVD mortality. The adjusted hazard ratios of 1.52 for all-cause and 1.52 for CVD mortality (p < 0.01) were higher than those for hypercholesterolemia and obesity, but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity, but substantially lower than those of hypertension, smoking and diabetes. The adjusted population-attributable risk (PAR) for DEEX accounted for about 15% for all-cause and CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors.

      Conclusions

      DEEX is a strong predictor of mortality risk, ranking in a medium position amongst classical somatic risk factors.

      Keywords

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