: Publication 4135

Publication 4135

Title:	Association Between Depressive Symptoms and Incident Cardiovascular Diseases
Journal:	JAMA
Published:	15 Dec 2020
Pubmed:	https://pubmed.ncbi.nlm.nih.gov/33320224/
DOI:	https://doi.org/10.1001/jama.2020.23068
URL:	https://jamanetwork.com/journals/jama/articlepdf/2774050/jama_harshfield_2020_oi_200124_1608571897.46073.pdf

Abstract

Importance: It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs).

Objective: To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.

Design, Setting, and Participants: A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline.

Exposures: Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder).

Main Outcomes and Measures: Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported.

Results: Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors.

Conclusions and Relevance: In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.

31 Authors

Eric L. Harshfield

Lisa Pennells

Joseph E. Schwartz

Peter Willeit

Stephen Kaptoge

Steven Bell

Jonathan A. Shaffer

Thomas Bolton

Sarah Spackman

Sylvia Wassertheil-Smoller

Frank Kee

Philippe Amouyel

Steven J. Shea

Lewis H. Kuller

Jussi Kauhanen

E. M. van Zutphen

Dan G. Blazer

Harlan Krumholz

Paul J. Nietert

Daan Kromhout

Gail Laughlin

Lisa Berkman

Robert B. Wallace

Leon A. Simons

Elaine M. Dennison

Elizabeth L. M. Barr

Haakon E. Meyer

Angela M. Wood

John Danesh

Emanuele Di Angelantonio

Karina W. Davidson

Abstract

12 Keywords

31 Authors