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Published on: April 25, 2014
Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated
Maaike Meurs1, Marij Zuidersma, Chris Dickens
1Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen / University of Groningen, Groningen, The Netherlands.
Insights
Depression after myocardial infarction (MI) is linked to worse outcomes. Even after accounting for the GRACE score, depressive symptoms still predict cardiovascular events, indicating a significant independent prognostic role.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Research
Background:
- Depressive symptoms post-myocardial infarction (MI) are linked to poorer cardiovascular (CV) prognosis.
- The extent to which this association is confounded by known prognostic factors remains unclear.
Purpose of the Study:
- To assess the relationship between post-MI depression and CV prognosis, adjusting for the Global Registry of Acute Coronary Events (GRACE) risk score.
- To determine if the GRACE score confounds the association between depression and prognosis.
Main Methods:
- Utilized data from 494 MI patients in the Depression after Myocardial Infarction (DepreMI) study.
- Assessed depressive symptoms using the Beck Depression Inventory (BDI) and correlated them with the GRACE risk score.
- Employed Cox regression analysis to evaluate the predictive value of depressive symptoms for prognosis, adjusting for the GRACE score.
Main Results:
- Depressive symptoms significantly correlated with the GRACE score (r=0.12, p=0.008).
- Somatic/affective symptoms positively correlated with GRACE score (r=0.23, p<0.001).
- Adjusting for the GRACE score did not alter the hazard ratio for recurrent CV events associated with total BDI score (aHR 1.05, p=0.002), and it only partially attenuated the HR for somatic/affective symptoms.
Conclusions:
- The GRACE score is positively associated with somatic/affective depressive symptoms post-MI.
- The GRACE score only partially explains the association between depressive symptoms and cardiovascular prognosis, suggesting an independent role for depression.
Background:
The presence of depressive symptoms after myocardial infarction (MI) is associated with worsened cardiovascular (CV) prognosis. To date, it remains unclear to what extent the relationship between post-MI depression and prognosis is confounded by factors related to prognosis. We assessed the relationship between depression and prognosis while adjusting for a well validated risk score for mortality after a MI.
Methods:
Data of 494 MI patients were derived from the Depression after Myocardial Infarction study (DepreMI). Scores on the Beck Depression Inventory (BDI) (cut-off ≥ 10) were used to relate depressive symptoms (divided in somatic/affective and cognitive/affective symptoms) to the Global Registry of Acute Coronary Events (GRACE) risk score, using Pearson correlations. Cox regression analysis was performed to investigate the predictive value of depressive symptoms for prognosis after adjusting for GRACE score.
Results:
Overall, depressive symptoms were significantly correlated with GRACE score (r=0.12, p=0.008). Specifically, somatic/affective symptoms were positively correlated (r=0.23, p<0.001), whereas cognitive/affective symptoms tended to be negatively correlated (r=-0.08, p=0.097) with GRACE score. Adjusting for GRACE score did not affect the HR for recurrent CV events associated with total BDI- score (adjusted hazard ratio (HR) per point increase in BDI score 1.05 p=0.002 95% CI 1.02-1.08 n=463). Furthermore GRACE score attenuated the HR associated with 1 SD increase in somatic/affective depressive symptoms from 1.44 (1.20-1.72) to 1.31 (1.08-1.58).
Conclusion:
GRACE score was positively associated with somatic/affective depressive symptoms. GRACE score explained only partly the association between (somatic/affective) depressive symptoms and CV prognosis.
