An examination of the moderating effect of treatment with anti-depressants on the association of heart disease with depression in males with type 2 diabetes attending a Veterans Affairs Medical Center

Objective: To examine the association of heart disease with depression and the impact of treatment with anti-depressants on this association in older males with type 2 diabetes. Research design and methods: In this cross-sectional study, data were collected from the electronic medical record system of the Veterans Affairs Medical Center (VAMC) in a large mid-western city in the United States. Subjects were 8185 males older than 40, with a history of type 2 diabetes, who had visited the VAMC within the previous 6 years. Odds ratios were used to measure bivariate associations; multivariate logistic regression was used to adjust for potential confounding factors. Results: After adjustments for confounding variables, significant associations were found between depression and any adverse heart event (OR = 1.34, p = 0.001), coronary artery disease (OR = 1.23, p = 0.039), myocardial infarction (MI; OR = 1.77, p < 0.001), and angioplasty (OR = 1.36, p = 0.034). Examination of the interaction between depression and anti-depressant prescription status indicated that, except for MI, these associations were no longer significant among those who had been prescribed anti-depressants, but remained significant and were increased in magnitude among those who had not been prescribed anti-depressants. Conclusions: These findings support the premise that co-morbid depression in diabetics is associated with the occurrence of adverse heart events, and further suggest that treatment of depression with anti-depressants moderates this association.