Abstract 16623: Elevated Depressive Symptoms Help Predict Major Adverse Cardiovascular Outcomes Irrespective of History of Depression

Abstract

Background: Although a clinical diagnosis of depression has been associated with worse long term outcome in patients with cardiovascular disease (CVD), whether patients who have elevated depressive symptoms without prior history of depression are similarly at increased risk is not clear.

Methods: To study depression, we obtained history of previous depression requiring drug treatment or counseling, and administered the Patient Health Questionnaire-9 (PHQ9) to 2824 patients undergoing coronary angiography (mean age 63 ± 12 years, 62% male). Patients were categorized into 4 categories;1) PHQ9<10 and no prior history of depression (n= 1939), 2) PHQ9 ≥10 and no prior history of depression (n=193), 3) PHQ9 <10 and prior history of depression(n=455), and 4) PHQ9 ≥10 and prior history of depression (n=237). They were followed for a mean period of 2.1 ± 1.1 years for all cause deaths and the composite endpoint of death and MI. Kaplan Meier and Cox regression models were adjusted for CVD risk factors including age, gender, hypertension, diabetes, dyslipidemia, smoking, presence and severity of CAD and medications.

Results: During follow-up, there were 204 deaths and 72 MIs. Compared to patients with PHQ9<10 and no prior depression, the HR for death for those with PHQ9<10 and prior depression was 1.4 (p=.06); for PHQ9 ≥10 and no prior depression, it was 1.7 (p=.02); and for PHQ9 ≥10 and prior depression it was 1.8 (p=.008). A PHQ9≥10 was associated with higher mortality both in presence (HR 1.54) and absence (HR 1.51) of previous history of depression (p<0.05). In contrast, a history of depression did not help stratify mortality risk in either presence (HR 1.16) or absence (HR 1.14) of a PHQ9≥10 (p=NS). Event free survival curve of these groups are shown in Figure 1. Similar differences between the groups were observed for the composite endpoint of death and MI.

Conclusion: Patients with a PHQ9 score ≥10 are at increased risk of adverse CVD events irrespective of a prior history of depression.