Depressive Symptom Clusters as Predictors of Incident Coronary Artery Disease

Abstract

Objective Because it is not known whether particular clusters of depressive symptoms are more cardiotoxic than others, we compared the utility of four clusters in predicting incident coronary artery disease (CAD) events over 15 years in large cohort of older primary care patients. Methods Participants were 2,537 primary care patients aged ≥ 60 years who were screened for depression between 1991–1993 and had no existing CAD diagnosis. Depressive symptoms clusters scores (depressed affect, somatic symptoms, interpersonal distress, and positive affect) were computed from responses on the Center for Epidemiologic Studies Depression Scale administered at baseline. CAD events, defined as the occurrence of a nonfatal acute myocardial infarction or CAD death during the follow-up period, were identified using electronic medical record and National Death Index data. Results There were 678 CAD events. In separate fully-adjusted Cox proportional hazard models (controlling for demographics and cardiovascular risk factors), the depressed affect (HR = 1.11, 95% CI: 1.04–1.20), somatic (HR = 1.17, 95% CI: 1.08–1.26), and positive affect (HR = 0.88, 95% CI: 0.82–0.95) clusters each predicted CAD events. When the depressive symptom clusters were entered simultaneously into the fully-adjusted model, however, only the somatic cluster remained predictive of CAD events (HR = 1.13, 95% CI: 1.03–1.23). Conclusions Our findings suggest that the longitudinal relationship between overall depressive symptom severity and incident CAD events may be driven primarily by the somatic cluster.

Relation of Persistent Depressive Symptoms to Coronary Artery Calcification in Women Aged 46 to 59 Years

“…Table 4 shows that, averaged over 5 years, the depressive symptoms subscales are similar to values in previous studies in older 19 as well as in younger people. 9 Only the subscales of depressed affect and interpersonal stress were significantly related to higher levels of CAC.…”

“…Self-reported anti-depressant medication used was verified by a clinical psychiatrist. Subscales of the CES-D were defined as in other published studies on subscales of the CES-D and CAC; 9, 19 depressed affect (eg, sadness and loneliness), somatic symptoms (eg, poor appetite and sleep disturbance), interpersonal distress (eg, feeling disliked), and (lack of) positive affect (eg, happiness and life satisfaction). As there are no accepted cut-points for the subscales, the average score over 5 years up to CAC assessment was calculated to yield a measure of chronicity of these symptoms.…”

Symptoms of depression and anxiety before and after myocardial infarction: The HUNT 2 and HUNT 3 study

“…Different types of depressive symptoms and clusters differ in their prognostic value in persons with CHD, and considering depression as a multidimensional disorder in research on CHD has been advocated (Baune et al, 2012;Doyle, Conroy, McGee, & Delaney, 2010;Hawkins, Callahan, Stump, & Stewart, 2013;Stewart et al, 2012). Although somatic symptoms of depression have been suggested as most important as predictors of CHD, positive affect is acknowledged as the second most important cluster (Hawkins et al, 2013). Anhedonia (reduced positive affect) has received attention both as a prognostic (Damen et al, 2013;Denollet et al, 2007;Leroy, Loas, & Perez-Diaz, 2010) and etiological factor (Davidson, Mostofsky, & Whang, 2010;Edmondson, Newman, Whang, & Davidson, 2013).…”

“…Guidelines on cardiovascular disease prevention (Perk et al, 2012) recommend that anxiety and depression should be included in the risk assessment of CHD, but lack specificity regarding types of screening or instruments to apply. Different types of depressive symptoms and clusters differ in their prognostic value in persons with CHD, and considering depression as a multidimensional disorder in research on CHD has been advocated (Baune et al, 2012;Doyle, Conroy, McGee, & Delaney, 2010;Hawkins, Callahan, Stump, & Stewart, 2013;Stewart et al, 2012). Although somatic symptoms of depression have been suggested as most important as predictors of CHD, positive affect is acknowledged as the second most important cluster (Hawkins et al, 2013).…”

Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study

“…Nicholson et al, 2006; Stampfer et al, 2012; Van der Kooy et al, 2007; Wulsin and Singal, 2003) and prospective studies (e.g. Gustad et al, 2013; Hawkins et al, 2013) strongly support that there is an association between depression and CHD. Among women, there has been an increased prevalence of CHD, and the role of depression as a gender-specific factor is still unclear (Naqvi et al, 2005).…”