Relationships Between Cardiovascular Disease Risk Factors and Depressive Symptoms as Predictors of Cardiovascular Disease Events in Women

Psychology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA.
Journal of Women's Health (Impact Factor: 2.05). 02/2012; 21(2):133-9. DOI: 10.1089/jwh.2011.2787
Source: PubMed


Modifiable risk factors for cardiovascular disease (CVD) account for much of the variability in CVD outcomes and are also related to psychosocial variables. There is evidence that depression can undermine the treatment and advance the progression of CVD risk factors, suggesting that CVD risk factor relationships with CVD events may differ among those with depression.
This study tracked CVD events and mortality over a median of 5.9 years among a prospective cohort of 620 women (mean age 59.6 years [11.6]) completing a diagnostic protocol including coronary angiography and CVD risk factor assessment. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). The study outcome was combined cardiovascular mortality and events.
Over the follow-up interval, 16.1% of the sample experienced one or more of the cardiovascular outcomes. In separate Cox regression models adjusting for age, education history, ethnicity, and coronary angiogram scores, we observed statistically significant CVD risk factor × BDI score interactions for diabetes, smoking, and waist-hip ratio factors. Simple effect analyses indicated that diabetes and smoking status were more strongly associated with cardiovascular outcomes among participants with lower BDI scores, whereas waist-hip ratio values predicted outcomes only among those with higher BDI scores.
These results suggest that the relationship between modifiable CVD risk factors and CVD outcomes may vary with depression status in clinical samples of women. This evidence augments prior research by demonstrating that depression may influence CVD risk jointly with or independent of CVD risk factors. It also provides further support for the inclusion of depression assessment in cardiovascular clinic settings.

Download full-text


Available from: Thomas Rutledge,
  • Source
    • "Depression on the day before surgery and depression that persists months after surgery were associated with a two- to threefold increased risk of mortality [18]. According to a recent study about women at high risk for cardiovascular disease not only the presence of depression but also the severity of depression influenced the outcome jointly with or independent of known risk factors [19]. Further research is needed to find the factors responsible for constant high STAI-T and BDI scores. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery. Methods After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths. Results During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained. Conclusions Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.
    Journal of Cardiothoracic Surgery 09/2012; 7(1):86. DOI:10.1186/1749-8090-7-86 · 1.03 Impact Factor

  • Journal of Women's Health 04/2012; 21(6):702; author reply 703. DOI:10.1089/jwh.2012.3626 · 2.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Scientific advances have led to substantial reductions in coronary heart disease (CHD) mortality over the past two decades. Impressive achievements in understanding sex differences in CHD outcomes are currently overshadowed by the limited exploration of the health disparities among young women with acute coronary syndromes (ACS). Even though patient-reported outcomes (PROs) such as perceived health and quality of life (QoL) independently predict cardiovascular events and mortality, there is a paucity of research on the determinants of PROs of young women. This review highlights the scientific evidence of the biological and psychosocial factors contributing to poor health and QoL among young women with ACS. Ascertaining the biopsychosocial determinants of PROs among young women will permit translation of this science into novel strategies for improved risk stratification and appropriate triage to age-specific and gender-sensitive personalized interventions that enhance self-management and reduce health differentials among this vulnerable cohort.
    Current Cardiovascular Risk Reports 01/2013; 8(1). DOI:10.1007/s12170-013-0366-1
Show more