Risk of Coronary Heart Disease Events Over 15 Years Among Older Adults With Depressive Symptoms

Objectives: To determine whether depression status is associated with an increased risk of coronary heart disease (CHD) events, defined as CHD death or nonfatal acute myocardial infarction (MI). Design: Prospective cohort study. Setting: An urban primary care practice. Participants: Two thousand sev...

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Published in:	The American journal of geriatric psychiatry 2011-08, Vol.19 (8), p.721-729
Main Authors:	Brown, Jessica M., M.S, Stewart, Jesse C., Ph.D, Stump, Timothy E., M.A, Callahan, Christopher M., M.D
Format:	Article
Language:	eng
Subjects:	Aged Cardiovascular disease Cohort Studies Comorbidity Coronary Disease - etiology Coronary Disease - mortality coronary heart disease depression Depression - complications Depression - diagnosis elderly Female Follow-Up Studies Geriatric Assessment Humans Indiana Internal Medicine Male Middle Aged Myocardial Infarction - etiology Myocardial Infarction - mortality primary care prospective study Risk Factors Self Report
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Summary:	Objectives: To determine whether depression status is associated with an increased risk of coronary heart disease (CHD) events, defined as CHD death or nonfatal acute myocardial infarction (MI). Design: Prospective cohort study. Setting: An urban primary care practice. Participants: Two thousand seven hundred twenty-eight adults (71.4% women, 65.5% black), age 60 years and older, who were screened for depression between 1991 and 1993. Measurements: Depressive symptom severity at baseline was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Data regarding baseline demographic and clinical variables, as well as laboratory evidence of acute MI, were obtained from an electronic medical record system. All-cause mortality and CHD death were determined from the National Death Index through 2006. Results: A total of 423 (15.5%) participants reported elevated symptoms of depression (CES-D score ≥16). During the 13 to 16 years of follow-up, 1,646 (60.3%) individuals died from any cause, and 727 (26.6%) died from CHD or suffered an acute MI. Cox proportional hazards models revealed that individuals with elevated depressive symptoms were more likely to experience a CHD event, even after adjustment for demographics and comorbid health conditions (relative risk = 1.46, 95% confidence interval: 1.20–1.77). Depression status was also a significant predictor of all-cause mortality in adjusted models. Conclusions: We report the longest prospective study to date to examine depression status as an independent risk factor for CHD among a cohort of older adults including large numbers of women and underrepresented minorities. The present findings underscore the need to consider depression as a common and modifiable risk factor for CHD events among older adults.
ISSN:	1064-7481 1545-7214