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

Abstract

BackgroundDepression 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 ResultsBetween 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.ConclusionsProximal 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.

Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study

“… 5 40 Although meta-analyses have shown a positive association, majority of the studies included in these meta-analyses did not take into account stroke risk factors such as BMI or alcohol use. 41 The results of this study were consistent with at least one prospective study which found that depression was not associated with stroke risk among older adults, after adequately controlling for covariates. 42 43 Taken together, depression did not appear to be a relevant risk factor of stroke in older adults.…”

Genetic and Environmental Relationships Between Depressive and Anxiety Symptoms and Cardiovascular Risk Estimates Among Korean Twins and Families

“…Despite these less consistent relationships according to sex, scales of anxiety assessment, and assessment time, current findings could be interpreted that increased depressive or anxiety symptoms could occur with higher CV risk estimates and predict higher CV risk estimates in the future. The observation would support previous knowledge about the associations between depressive and anxiety symptoms and CVD and CV risk factors (Batelaan et al, 2016;Castaneda et al, 2016;de Miranda Azevedo et al, 2014;Lopez-Leon et al, 2010;Moise et al, 2016;Rutledge et al, 2009;Salaycik et al, 2007;Scherrer et al, 2003;Shen et al, 2008;Ye et al, 2013).…”

Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study

“… 1 9 Nonetheless, our previously published study, which excluded those with a history of CVD, similarly found a strong relationship between time-varying depressive symptoms and CVD death. 31 …”