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Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke ( REGARDS ) Study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Depression is a relapsing and remitting disease. Prior studies on the association between depressive symptoms and incident cardiovascular disease (CVD) have been limited by single measurements, and few if any have examined both incident coronary heart disease and stroke in a large biracial national cohort. We aimed to assess whether time‐dependent depressive symptoms conferred increased risk of incident CVD.

Methods and results: Between 2003 to 2007, 22 666 black and white participants (aged ≥45 years) without baseline CVD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were recruited. Cox proportional hazards regression analyses assessed the association between up to 3 measurements of elevated depressive symptoms (4‐item Center for Epidemiologic Studies Depression Scale score ≥4) and incident coronary heart disease, stroke, and CVD death adjusting for age, sex, region, income, health insurance, education, blood pressure, cholesterol, medication, obesity, diabetes mellitus, kidney disease, C‐reactive protein, corrected QT interval, atrial fibrillation, left ventricular hypertrophy, smoking, alcohol, physical inactivity, medication adherence, and antidepressant use. The participants’ average age was 63.4 years, 58.8% were female, and 41.7% black. Time‐varying depressive symptoms were significantly associated with CVD death (adjusted hazard ratio 1.30, 95% CI 1.04–1.63), with a trend toward significance for fatal and nonfatal stroke (adjusted hazard ratio 1.26, 95% CI 0.99–1.60) but not fatal and nonfatal coronary heart disease (adjusted hazard ratio 1.11, 95% CI 0.89–1.38). Race did not moderate the association between depressive symptoms and CVD.

Conclusions: Proximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier graphs of depression and CVD events and deaths on or before December 31, 2012. Kaplan–Meier curves and log‐rank P values for the relationship between depressive symptoms and fatal and nonfatal CHD (A), fatal and nonfatal stroke (B), and CVD death (C). CES‐D indicates Center for Epidemiologic Studies Depression Scale; CHD, coronary heart disease; CVD, cardiovascular disease.
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jah31691-fig-0002: Kaplan–Meier graphs of depression and CVD events and deaths on or before December 31, 2012. Kaplan–Meier curves and log‐rank P values for the relationship between depressive symptoms and fatal and nonfatal CHD (A), fatal and nonfatal stroke (B), and CVD death (C). CES‐D indicates Center for Epidemiologic Studies Depression Scale; CHD, coronary heart disease; CVD, cardiovascular disease.

Mentions: The median follow‐up time was 6.9 years. Among participants with elevated depressive symptoms at any of the 3 assessments, there were 96 (10.7%) CHD events, 81 (12.2%) strokes, and 94 (13.4%) CVD deaths. In the unadjusted analyses, the HR for CHD associated with time‐varying depressive symptoms was 1.15 (95% CI 0.93–1.42), which remained similar after adjusting for demographics, traditional CVD, and other explanatory behavioral and physiological factors (Table 2). The unadjusted HR for fatal and nonfatal stroke with depressive symptoms was 1.35 (95% CI 1.07–1.70). The adjusted HR (aHR) for fatal and nonfatal stroke was 1.31 (95% CI 1.04–1.67) after controlling for demographic and traditional CVD risk factors, 1.30 (1.02–1.65) after adjusting for behavioral factors, and 1.26 (0.99–1.60) after additionally adjusting for other physiological factors. Time‐varying depressive symptoms were significantly associated with CVD death in the unadjusted analysis (HR 1.49, 95% CI 1.20–1.85) and remained so after adjusting for demographics and traditional CVD risk factors (aHR 1.36, 95% CI 1.09–1.70), behavioral risk factors (aHR 1.35, 95% CI 1.08–1.68), and other explanatory physiological factors (aHR 1.30, 95% CI 1.04–1.63) (Figure 2).


Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke ( REGARDS ) Study
Kaplan–Meier graphs of depression and CVD events and deaths on or before December 31, 2012. Kaplan–Meier curves and log‐rank P values for the relationship between depressive symptoms and fatal and nonfatal CHD (A), fatal and nonfatal stroke (B), and CVD death (C). CES‐D indicates Center for Epidemiologic Studies Depression Scale; CHD, coronary heart disease; CVD, cardiovascular disease.
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jah31691-fig-0002: Kaplan–Meier graphs of depression and CVD events and deaths on or before December 31, 2012. Kaplan–Meier curves and log‐rank P values for the relationship between depressive symptoms and fatal and nonfatal CHD (A), fatal and nonfatal stroke (B), and CVD death (C). CES‐D indicates Center for Epidemiologic Studies Depression Scale; CHD, coronary heart disease; CVD, cardiovascular disease.
Mentions: The median follow‐up time was 6.9 years. Among participants with elevated depressive symptoms at any of the 3 assessments, there were 96 (10.7%) CHD events, 81 (12.2%) strokes, and 94 (13.4%) CVD deaths. In the unadjusted analyses, the HR for CHD associated with time‐varying depressive symptoms was 1.15 (95% CI 0.93–1.42), which remained similar after adjusting for demographics, traditional CVD, and other explanatory behavioral and physiological factors (Table 2). The unadjusted HR for fatal and nonfatal stroke with depressive symptoms was 1.35 (95% CI 1.07–1.70). The adjusted HR (aHR) for fatal and nonfatal stroke was 1.31 (95% CI 1.04–1.67) after controlling for demographic and traditional CVD risk factors, 1.30 (1.02–1.65) after adjusting for behavioral factors, and 1.26 (0.99–1.60) after additionally adjusting for other physiological factors. Time‐varying depressive symptoms were significantly associated with CVD death in the unadjusted analysis (HR 1.49, 95% CI 1.20–1.85) and remained so after adjusting for demographics and traditional CVD risk factors (aHR 1.36, 95% CI 1.09–1.70), behavioral risk factors (aHR 1.35, 95% CI 1.08–1.68), and other explanatory physiological factors (aHR 1.30, 95% CI 1.04–1.63) (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Depression is a relapsing and remitting disease. Prior studies on the association between depressive symptoms and incident cardiovascular disease (CVD) have been limited by single measurements, and few if any have examined both incident coronary heart disease and stroke in a large biracial national cohort. We aimed to assess whether time‐dependent depressive symptoms conferred increased risk of incident CVD.

Methods and results: Between 2003 to 2007, 22 666 black and white participants (aged ≥45 years) without baseline CVD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were recruited. Cox proportional hazards regression analyses assessed the association between up to 3 measurements of elevated depressive symptoms (4‐item Center for Epidemiologic Studies Depression Scale score ≥4) and incident coronary heart disease, stroke, and CVD death adjusting for age, sex, region, income, health insurance, education, blood pressure, cholesterol, medication, obesity, diabetes mellitus, kidney disease, C‐reactive protein, corrected QT interval, atrial fibrillation, left ventricular hypertrophy, smoking, alcohol, physical inactivity, medication adherence, and antidepressant use. The participants’ average age was 63.4 years, 58.8% were female, and 41.7% black. Time‐varying depressive symptoms were significantly associated with CVD death (adjusted hazard ratio 1.30, 95% CI 1.04–1.63), with a trend toward significance for fatal and nonfatal stroke (adjusted hazard ratio 1.26, 95% CI 0.99–1.60) but not fatal and nonfatal coronary heart disease (adjusted hazard ratio 1.11, 95% CI 0.89–1.38). Race did not moderate the association between depressive symptoms and CVD.

Conclusions: Proximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.

No MeSH data available.


Related in: MedlinePlus