Abstract 15230: Depression is a Stronger Risk Factor for Obstructive Coronary Artery Disease and Major Cardiovascular Events in Young Women than Men and Older Women
Introduction: Depression is a cardiovascular risk factor that is highly prevalent in young women, a group that also shows a disproportionately increased risk of adverse events after an acute MI. We investigated whether young women with depression have higher risk of obstructive coronary disease and of adverse outcomes compared to young men and older women.
Methods: We analyzed 2044 patients undergoing coronary angiography for suspected CAD. Obstructive disease was quantified by the number of major vessels with ≥70% stenosis (or ≥ 50% for the left main). Depression was defined as a Patient Health Questionnaire (PHQ-9) score ≥ 10. Primary outcomes, ascertained by phone interview or chart review, were death and repeat hospitalizations for major cardiovascular events (MACE), including unstable angina, MI, revascularization, CHF, TIA, or stroke. Associations between depression and CAD/MACE were stratified according to sex and age, and adjusted analyses were performed using partial Spearman correlation and Cox proportional hazards models.
Results: Patients were followed for a mean ± SD of 2.3 ± 1.1 years. The mean ± SD age was 62.5 ± 10.5 years, and 34% were women. After multivariable adjustment for CAD risk factors and reason for catheterization, depressive symptoms correlated with higher CAD burden in women < 55 years old (r=0.21, 95% confidence interval (CI), 0.05, 0.35), but not in men < 55 years (r=-0.07, 95% CI, -0.18, 0.05), or women > 65 years (r=-0.01, 95% CI, -0.13, 0.11) of age, p<0.05 for the age and sex interaction with depression. Depressed women < 55 years of age also had a higher adjusted relative risk (RR) of MACE (3.62, 95% CI 1.32, 9.67) as opposed to men < 55 years (RR 0.29, 95% CI 0.08, 0.98, sex-depression interaction p=0.002) and women > 65 years (RR 1.72, 95% CI, 0.71-4.14). Additional adjustment for CAD burden modestly reduced the RR in young women (RR 3.23, 95% CI, 1.17-8.91).
Conclusion: In patients undergoing angiography for suspected CAD, depression was associated with obstructive CAD and MACE only in women < 55 years of age. Given the disproportionately high prevalence of depression in young women, further research into the cardiotoxic effects of depression in this population is warranted.
- © 2011 by American Heart Association, Inc.