Abstract 1121: Depression is a Stronger Correlate of Coronary Artery Disease in Women Than Men Among Young and Middle-aged Patients
Introduction Younger, but not older, women with CAD have worse outcomes than men of similar age, but the reasons are unclear. Depression is a recognized risk factor for CAD and is common in women. It is possible that depression is a stronger risk factor for CAD in younger women than men.
Hypothesis We hypothesized that depression is more strongly related to presence and of CAD in younger women than men of similar age, while no difference would be observed in older patients.
Methods We studied 1587 patients <65 years and 1358 patients ≥65 years in a prospective registry of patients referred for cardiac catheterization. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ9) and depression was defined as having a PHQ9≥10. The likelihood of significant CAD (defined as ≥50% occlusion in any major coronary artery) was compared between men and women in two age strata (<65 years and ≥65 years). Logistic regression was used to adjust for demographics, medical history and CAD risk factors.
Results There were 513 women (32%) in the younger group and 464 women (34%) in the older group. In the younger group women had twice the prevalence of depression than men: 22% vs. 13% (p=<0.0001), but there were no significant differences in the older group (p=0.17). Younger women with depression had a higher prevalence of CAD (40% vs. 58%, p=0.001), while no difference was noted in men (64% vs 62%), p=0.004 for the sex-depression interaction. In models adjusted for demographics, medical history and CAD risk factors, depression was associated with nearly double the odds of CAD in younger women (OR 1.82, CI 1.01–3.26), while no association was found in younger men (OR 0.62, CI 0.37–1.03), p=0.006 for the interaction. As a continuous variable, each point increase in the PHQ-9 score was associated with 4% increase in the odds of CAD in women (p=0.1108) and 3% decrease in men (p=0.1199), P=0.005 for the interaction. There was no association between depression and CAD in older men and women.
Conclusion Depression is associated with CAD only in younger women (<65 years). Depression appears to be a uniquely important risk factor for younger women, and could potentially contribute to excess risk of adverse outcomes for this group compared with men.