Depressive symptoms independently linked to CVD risk: JAMA
UK: Depressive symptoms are associated with a modest increase in the risk of cardiovascular disease (CVD), suggests a recent study in the journal JAMA. The risk was evident even for people having depressive symptoms lower than the threshold indicative of a depressive disorder.
Whether depressive symptoms are independently associated with subsequent CVD risk is uncertain. Considering this, Eric L. Harshfield, University of Cambridge, Cambridge, United Kingdom, and colleagues aimed to characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.
For the purpose, the researchers conducted a pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants) and the UK Biobank (401 219 participants). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline.
Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder).
Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2).
Key findings of the study include:
- Among 162 036 participants from the ERFC (73%, women), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years).
- Associations with CHD, stroke, and CVD were log linear.
- The HR per 1-SD higher depression score for CHD was 1.07; stroke, 1.05; and CVD, 1.06.
- The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events.
- Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years), 4607 CHD and 3253 stroke events were recorded.
- The HR per 1-SD higher depression score for CHD was 1.11; stroke, 1.10; and CVD, 1.10.
- The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events.
- The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors.
"In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest," concluded the authors.
The study, "Association Between Depressive Symptoms and Incident Cardiovascular Diseases," is published in the journal JAMA.