Can depression help set the stage for a deadly heart attack? It looks like it, an ever-growing arsenal of studies suggests.

Dutch investigators, for instance, pinpointed the incidence of major depression in some 3,000 men and women aged 55 years and older, then followed them for four years. Those persons who had been substantially depressed, it turned out, were about twice as likely to die subsequently as those who had not been depressed, and the means of death in many of those cases appeared to have been a heart attack.

Furthermore, Alabama investigators focused on some 3,000 Canadians and found that those subjects who were depressed were twice as likely as those who were not to succumb to a heart disease–related hospitalization.

And now, Abraham Ariyo, M.D., of Johns Hopkins Medical Institutions in Baltimore and colleagues have come up with still more provocative results along these lines. They used the Depression Scale of the Center for Epidemiological Studies to identify depression in some 5,000 persons aged 65 years or older, both at the start of the study and annually for another six years after that. During those six years, they also kept tract of which subjects developed coronary disease or died. And at the end of the six years, they attempted to see whether they could link preexisting depression in subjects with subsequent heart disease or death.

They could, they reported in the October 17 Circulation, a journal of the American Heart Association. Among participants with the highest cumulative mean depression scores, the risk of coronary heart disease increased by 40 percent and risk of death by 60 percent, compared with those who had the lowest cumulative mean depression scores.