Anhedonia Predicts Major Adverse Cardiac Events and Mortality in Patients 1 Year After Acute Coronary Syndrome

Context—Depression is a consistent predictor of recurrent events and mortality in ACS patients, but it has 2 core diagnostic criteria with distinct biological correlates—depressed mood and anhedonia. Objective—To determine if depressed mood and/or anhedonia (loss of pleasure or interest) predict 1-year medical outcomes for patients with Acute Coronary Syndrome (ACS). Design—Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within one week of admission, patients underwent a structured psychiatric interview to assess clinically impairing depressed mood, anhedonia, and major depressive episode (MDE); also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity. Setting—Coronary care and cardiac care step-down units of 3 university hospitals in New York and Connecticut. Participants—Consecutive sample of 453 ACS patients (aged 25–93 years; 42% women). Main Outcomes Measures—All-cause mortality (ACM) and documented major adverse cardiac events (MACE; myocardial infarction, hospitalization for unstable angina, or urgent revascularization) were actively surveyed for 1 year after admission. Results—There were 67 events (16 deaths and 51 MACE; 14.8%). 108 (24%) and 77 (17%) patients with anhedonia and depressed mood, respectively. After controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16–2.14; P<.01) and MDE (adjusted hazard ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.02) were significant predictors of combined MACE/ACM, but depressed mood was not. Anhedonia continued to significantly predict outcomes controlling for MDE diagnosis and depressive symptom severity, each of which were no longer significant. Corresponding Author: Karina W. Davidson, PhD, Department of Medicine, Columbia University College of Physicians and Surgeons, Room 948, PH9 Center, 622 W 168th St, New York, NY 10032; [email protected]; phone: 212-342-4493; fax: 212-342-3431. NIH Public Access Author Manuscript Arch Gen Psychiatry. Author manuscript; available in PMC 2011 March 16. Published in final edited form as: Arch Gen Psychiatry. 2010 May ; 67(5): 480–488. doi:10.1001/archgenpsychiatry.2010.36. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Conclusions—Anhedonia identifies risk for MACE/ACM beyond that of established medical prognostic indicators. Biological correlates of anhedonia may add to the understanding of the link between depression and heart disease.