Abstract 15003: The Association of Depression Severity to Future Death and Incident Cardiovascular Disease Overall and Stratified by Age
Background: Depression has been reported to be associated with increased risk of death and cardiovascular (CV) disease. Although limited, there is some evidence that this elevated risk may vary by age and symptom severity.
Methods: Pts (N=44,331) within an integrated healthcare system who were administered the patient health questionnaire (PHQ-9) within a primary care setting (>85 primary care clinics), ≤40 yrs of age, and without prior CV disease were studied. The first questionnaire completed was used to assess depression and symptom severity. Symptom severity was categorized as: none (score 0-9), mild (score 10-14), moderate (score 15-19), and severe (score ≤20). Cox hazard regression was used to evaluate the association of depression severity overall and by age (40-54 yrs [n=22,987], 55-69 yrs [n=15,435], and ≤70 yrs [n=5909]) to all-cause death, CAD, CVA, and MACE (death, CAD, CVA).
Results: Pts were 66% female, 36% had hypertension, 17% smoked, and 15% were diabetic. Symptom severity for none, mild, moderate, and severe depression was 58.5% 17.4%, 13.6%, and 10.5%, respectively. Those 40-54 yrs were diagnosed more frequently with depression at all severity levels compared to those that were older (see Table, p<0.0001). Specifically, pts 55-69 yrs (odd ratio [OR]=0.84, p<0.0001) and ≤70 yrs (OR=0.73, p<0.0001) were less likely to be diagnosed with depression (severe/moderate vs. mild/none) than patients 40-54 yrs, even after adjustment by CV risk factors. Frequency of long-term outcomes and multivariable hazard ratios overall and stratified by age are shown in Table.
Conclusion: Among a primary prevention cohort, depression was found to be highly prevalent, with frequency increasing with decreasing age. Symptom severity of depression was found to be associated with incident death and CV disease in a step-wise manner. Whether more aggressive management of depression, even in young patients, can reduce the risk of these adverse outcomes needs further study.
Author Disclosures: H.T. May: None. T.L. Bair: None. B. Reiss-Brennan: None. S. Knight: None. J.L. Anderson: None. B.D. Horne: None. K.D. Brunisholz: None. J.B. Muhlestein: None.
- © 2014 by American Heart Association, Inc.