Abstract 12070: The Association between Depression and Incident Stroke in Women
Background: Depression after stroke is a widely recognized clinical phenomenon; however, whether depression increases the risk of incident stroke remains uncertain.
Methods: A total of 62,035 women in the Nurses' Health Study, aged 50–75 years and free of diagnosed heart disease, cancer and stroke in 1996, were followed through 2006. Depression was defined as having clinician-diagnosed depression or clinically significant depressive symptoms, i.e., a Mental Health Index (MHI-5) score ≤52; depressed cases were further sub-divided by use of antidepressant medications. Strokes were confirmed by physician review. Analyses were adjusted for established risk factors for cardiovascular disease and depression.
Results: During 10 years of follow-up, 1,096 incident strokes were documented (122 hemorrhagic, 617 ischemic, and 357 unspecified strokes). Compared to participants without depression, depressed individuals had a significantly elevated risk of developing total stroke (relative risk [RR], 1.47; 95% confidence interval [CI], 1.26−1.70). Stroke risk was particularly increased among women who received a clinician diagnosis of depression, with or without antidepressant use. Depression was associated with an increased risk of ischemic stroke (RR, 1.38; 95% CI, 1.12−1.69), but power was limited to assess hemorrhagic stroke (RR, 1.39; 95% CI, 0.89−2.16). Use of selective serotonin reuptake inhibitors (SSRIs) was associated with an elevated risk of stroke, which remained significant after adjusting for mental health scores (RR, 1.43; 95% CI, 1.08–1.89). Intriguingly, women with late-life, new onset depression (incident after 1996) had the highest RR of stroke (1.57; 95% CI, 1.29–1.93). Finally, increasing mental health score showed a monotonic association with risk of stroke: compared to women with MHI-5 scores of 86–100, the RRs were 1.03 (0.91–1.16), 1.18 (1.03–1.35), 1.41 (1.15–1.73) for scores of 75–86, 53–75, 0–52, respectively (P trend<0.001).
Conclusions: Our results provide supportive evidence that clinical depression may increase the risk of incident stroke. Associations between depression and stroke - including new-onset, late-life depression, sub-clinical depression and SSRI use to stroke risk - deserve further scrutiny.
- © 2010 by American Heart Association, Inc.