Depressive symptoms and cardiovascular burden-related mortality among the aged
Matti Hiltunen1, Tuomo Nieminen, Raimo Kettunen
1Department of Clinical Neurophysiology, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine, Lahti, Finland.
Insights
In elderly individuals, depressive symptoms predict mortality only when cardiovascular factors are ignored. B-type natriuretic peptide (BNP) consistently predicts mortality, independent of depression status.
Area of Science:
- Gerontology
- Cardiology
- Psychiatry
Background:
- Depressive symptoms are associated with increased cardiovascular mortality in older adults.
- B-type natriuretic peptide (BNP) is a direct marker of cardiovascular stress and mortality predictor.
- This study investigates the combined predictive value of depressive symptoms and BNP on mortality in the elderly.
Purpose of the Study:
- To evaluate the independent and additive predictive value of depressive symptoms and BNP on total and cardiovascular mortalities.
- To assess these predictors in conjunction with traditional cardiovascular risk markers in a general elderly population.
Main Methods:
- A cohort of 508 individuals aged 75 years and older was studied.
- Cox regression analyses were employed to assess the prognostic capacity of depressive symptoms and BNP.
- Depressive symptoms were dichotomized using the Zung self-rated depression scale (cut-off: 40).
Main Results:
- Depressive symptoms predicted all-cause and cardiovascular mortalities in univariable analyses (HR 1.60 and 1.81, respectively).
- Depressive symptoms lost independent predictive significance for mortality when cardiovascular risk factors were accounted for.
- BNP significantly predicted both all-cause and cardiovascular mortalities in fully adjusted models (HR 1.44 and 1.79, respectively).
Conclusions:
- The predictive power of depressive symptoms for mortality in the elderly is linked to underlying cardiovascular morbidity and lacks independent prognostic value.
- B-type natriuretic peptide (BNP) remains a robust predictor of mortality, irrespective of depressive symptom status in this population.
Background:
Depressive symptoms have been linked to increased cardiovascular mortality among the elderly. This study was aimed to test the independent and additive predictive value of depressive symptoms and B-type natriuretic peptide (BNP), a marker of direct cardiovascular stress and a strong predictor of mortality, together with traditional cardiovascular risk markers on total and cardiovascular mortalities in a general elderly population.
Methods:
A total of 508 subjects aged 75 or older participated in the study. The prognostic capacity of depressive symptoms and BNP in regard to total and cardiovascular mortalities was assessed with Cox regression analyses. Depressive symptoms were handled as a dichotomous variable based on the Zung self-rated depression scale score with a cut-off point of 40.
Results:
The median follow-up time was 84 months with an interquartile range of 36-99 months. Depressive symptoms reflected susceptibility to all-cause (HR 1·60; 95% CI 1·26-2·04) and cardiovascular mortalities (HR 1·81; 95% CI 1·30-2·52) only in univariable analyses. When cardiovascular illnesses and risk markers were taken into account, depressive symptoms lost their significance as an independent predictor of mortality. BNP as a continuous variable was a significant predictor of both all-cause (HR 1·44; 95% CI 1·22-1·69) and cardiovascular mortalities (HR 1·79; 95% CI 1·44-2·22) in fully adjusted models including depressive symptoms as a covariate.
Conclusions:
The prognostic capacity of depressive symptoms is closely linked to cardiovascular morbidity and has no independent power in an elderly general population. BNP remains a strong harbinger of death regardless of depressive symptoms status.
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