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(Circulation. 2000;102:1773.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Depressive Symptoms and Risks of Coronary Heart Disease and Mortality in Elderly Americans
From the Divisions of Cardiovascular Medicine (A.A.A.) and Endocrine (A.D), Johns Hopkins University, Baltimore, Md; the Divisions of Cardiovascular Medicine (J.C.R), Epidemiology and Prevention (M.H.), University of California-Davis; the Department of Biostatistics (C.M.T.), University of Washington, Seattle, Wash; Department of Pathology (M.C.), University of Vermont, Burlington; and the Department of Public Health Sciences (C.D.F.), Wake Forest University, Winston-Salem, NC. Correspondence to Dr Abraham A. Ariyo, Cardiovascular Division, Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 568, Baltimore, MD 21287.
Background—Several epidemiological studies have associated depressive symptoms with cardiovascular disease. We investigated whether depressive symptoms constituted a risk for coronary heart disease (CHD) and total mortality among an apparently healthy elderly cohort.
Methods and Results—In a prospective cohort of 5888 elderly
Americans (
65 years) who were enrolled in the
Cardiovascular Health Study, 4493 participants who were
free of cardiovascular disease at baseline provided
annual information on their depressive status, which was assessed using
the Depression Scale of the Center for Epidemiological Studies. These
4493 subjects were followed for 6 years for the development of CHD and
mortality. The cumulative mean depression score was assessed for each
participant up to the time of event (maximum 6-year follow-up). Using
time-dependent, proportional-hazards models, the unadjusted hazard
ratio associated with every 5-unit increase in mean depression score
for the development of CHD was 1.15 (P=0.006); the ratio
for all-cause mortality was 1.29 (P<0.0001). In
multivariate analyses adjusted for age, race,
sex, education, diabetes, hypertension, cigarette smoking, total
cholesterol, triglyceride level, congestive
heart failure, and physical inactivity, the hazard ratio for CHD was
1.15 (P=0.006) and that for all-cause mortality was 1.16
(P=0.006). Among participants with the highest
cumulative mean depression scores, the risk of CHD increased by 40%
and risk of death by 60% compared with those who had the lowest mean
scores.
Conclusions—Among elderly Americans, depressive symptoms constitute an independent risk factor for the development of CHD and total mortality.
Key Words: risk factors • epidemiology • coronary disease • mortality • depression
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