Depression severity and major cardiovascular events: Findings from German insurance claims data

BACKGROUND: Previous studies have linked depression and depressive symptoms to major adverse cardiovascular events (MACE, i.e. stroke and acute myocardial infarction (AMI)) and mortality. However, data on the association of diagnosed depressive disorders and MACE in large samples are scarce. In the present study, we aim to assess the association of depression diagnoses and depression severity with the risk for MACE and all-cause mortality. METHODS: This retrospective cohort study included health insurance data from 1,314,289 individuals in Germany. Depressive disorders and depression severity were defined by ICD-10 codes. Patients with MACE during a three-year pre-observation period were excluded. Incident MACE and all-cause deaths were recorded over a six-year follow-up. Adjusted hazard ratios (HR) and 95% confidence intervals (95%CI) were computed by cox proportional hazard models with confounders age, sex, cardiometabolic- and substance use disorders. RESULTS: Depression was significantly associated with increased risk for MACE (HR 1.16, 95%CI 1.14-1.18), reflected by heightened risk for AMI (HR 1.10, 95%CI 1.06-1.13) and stroke (HR 1.20, 95%CI 1.17-1.23). MACE risk increased with greater depression severity (mild: HR 1.09, 95%CI 1.05-1.13; moderate: HR 1.19, 95%CI 1.15-1.23; severe: HR 1.19, 95%CI 1.14-1.24). Similarly, depression was significantly linked to augmented mortality risk (HR 1.20, 95%CI 1.18-1.21), depending on depression severity (mild: HR 1.07, 95%CI 1.05-1.09; moderate: HR 1.21, 95%CI 1.18-1.23; severe: HR 1.29, 95%CI 1.26-1.32). CONCLUSION: This study demonstrates a significant association between depression and increased risk for MACE and mortality in a large German health insurance claims sample. Additionally, it highlights that depression severity is linked to both, MACE and mortality risk, underscoring the urgent need for targeted cardiovascular disease prevention strategies in patients with clinical depression.