Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease
Mary A Whooley1, Peter de Jonge, Eric Vittinghoff
1VA Medical Center, San Francisco, California, USA. mary.whooley@ucsf.edu
JAMA
|November 27, 2008
Summary
Depressive symptoms in coronary heart disease patients increase cardiovascular event risk, but this link is mainly due to behavioral factors like physical inactivity, not biological causes.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depressive symptoms are linked to worse cardiovascular outcomes in patients with coronary heart disease (CHD).
- The underlying mechanisms connecting depression and cardiovascular events in CHD patients remain unclear.
Purpose of the Study:
- To investigate the reasons behind the association between depressive symptoms and increased risk of cardiovascular events in CHD patients.
Main Methods:
- Prospective cohort study of 1017 outpatients with stable coronary heart disease.
- Depressive symptoms assessed using the Patient Health Questionnaire (PHQ).
- Proportional hazards models used to analyze the association between depressive symptoms and cardiovascular events, adjusting for disease severity and biological/behavioral mediators.
Main Results:
- A total of 341 cardiovascular events occurred during follow-up.
- Depressive symptoms were associated with a 31% higher rate of cardiovascular events after adjusting for comorbidities and disease severity.
- This association was attenuated by biological mediators and became non-significant after adjusting for behavioral factors, particularly physical inactivity.
Conclusions:
- The link between depressive symptoms and adverse cardiovascular events in CHD patients is primarily explained by behavioral factors.
- Physical inactivity emerges as a key mediator in this association.
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