Depressive Symptoms May Be Associated with Cardiovascular Disease

A study observed a correlation between depressive symptoms, even when the symptoms were at levels lower than what would be indicative of a depressive disorder, and incident cardiovascular disease (CVD), although the researchers noted that “the magnitude of the association was modest.”

They analyzed the Emerging Risk Factors Collaboration (ERFC) for data on 162,036 participants and the UK Biobank for data on 401,219 participants. The ERFC consisted of 21 cohorts, and baseline surveys were conducted between 1960 and 2008. For the UK Biobank, baseline surveys were performed from 2006 through 2010. In both groups, the latest follow-up was March 2020. All participants had self-reported depressive symptoms and no history of CVD at baseline. The main outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD, defined as a composite of CHD and stroke.

In the ERFC, 73% of participants were female, and mean age at baseline was 63 years (standard deviation [SD], 9 years). At a median follow-up of 9.5 years, 5,078 CHD and 3,932 stroke events occurred. Log linear associations were observed with all three outcomes. Hazard ratios (HRs) per 1-SD higher depression score were: CHD, 1.07 (95% confidence interval [CI], 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). When comparing the highest versus lowest quintile of Center for Epidemiological Studies Depression score (range, 0-60; ≥16 indicates possible depressive disorder), incidence rates per 10,000 person-years of follow-up were: CHD events, 36.3 versus 29.0; stroke events, 28.0 versus 24.7; and CVD events, 62.8 versus 53.5.

Participants in the UK Biobank were younger (mean age at baseline, 56 years [SD, 8 years]) and less likely to be female (55%). At a median follow-up of 8.1 years, 4,607 CHD and 3,253 stroke events occurred. HRs per 1-SD higher depression were: CHD, 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). When comparing patients with 2-item Patient Health Questionnaire 2 (range, 0-6; ≥3 indicates possible depressive disorder) of 4 or higher versus 0, incidence rates per 10,000 person-years of follow-up were: CHD events, 20.9 versus 14.2; stroke events, 15.3 versus 10.2; and CVD events, 36.2 versus 24.5.

The study was published in JAMA.