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Published on: August 28, 2018
Relation of Persistent Depressive Symptoms to Coronary Artery Calcification in Women Aged 46 to 59 Years
Imke Janssen1, Lynda H Powell2, Karen A Matthews3
1Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois.
Insights
Persistent high depressive symptoms in midlife women are linked to increased coronary calcium, indicating early cardiovascular disease development. This association was observed regardless of race, highlighting a significant health concern.
Area of Science:
- Cardiovascular Disease Research
- Mental Health and Atherogenesis
- Women's Health Studies
Background:
- Depressive disorders are linked to cardiovascular disease (CVD), but their impact on early atherogenesis, especially in midlife women, remains unclear.
- The relationship between recurrent depressive symptoms and coronary calcium (CAC) in middle-aged women, a demographic where depression is prevalent, is not well-established.
- Understanding these links is crucial for identifying at-risk populations and developing targeted preventive strategies.
Purpose of the Study:
- To investigate the association between repeated episodes of high depressive symptoms and the presence of coronary calcium (CAC) in midlife women.
- To determine if this association differs by race.
- To explore the impact of persistent depressive symptoms on subclinical cardiovascular disease development in women without pre-existing CVD or diabetes.
Main Methods:
- Longitudinal analysis of 5-year depressive symptom data (Center for Epidemiological Studies Depression Scale [CES-D scale]) from the Study of Women's Health Across the Nation Heart study.
- Participants were classified as having high depressive symptoms (CES-D ≥16) or not, with repeated episodes quantified.
- Coronary calcium (CAC) was measured using computed tomography and analyzed categorically; statistical models adjusted for CVD risk factors.
Main Results:
- In middle-aged women (46-59 years) free of CVD and diabetes, 19% had one, 9% had two, and 11% experienced three or more episodes of high depressive symptoms over 5 years.
- Women with three or more episodes of high depressive symptoms were twice as likely to have significant CAC (≥10 Agatston units) compared to those with no episodes (OR 2.20, p=0.020), irrespective of race.
- No significant association was found for women with one or two episodes of high depressive symptoms.
Conclusions:
- Persistent depressive symptoms, defined as three or more episodes over 5 years, are significantly associated with elevated CAC scores in healthy, middle-aged women.
- This suggests that chronic depression may have pathophysiological and behavioral effects contributing to subclinical CVD development.
- The findings underscore the importance of addressing persistent depression in midlife women to mitigate cardiovascular risk.
Abstract:
Depressive disorders have been associated with cardiovascular disease (CVD), but the impact of depression on early atherogenesis has not been well described, particularly in women and minorities. The relation between repeated episodes of high depressive symptoms and coronary calcium (CAC) is unknown in women at midlife when depression is common. Participants in the Study of Women's Health Across the Nation Heart study were assessed annually for depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D scale]) over 5 years before CAC assessment and classified as high (CES-D ≥16) or not. CAC, measured by computed tomography, was analyzed as a categorical variable using cumulative logit partial proportional odds models. In these middle-aged women free of CVD and diabetes (194 black, 334 white), high depressive symptoms over 5 years were common; 19% had 1, 9% had 2, and 11% experienced ≥3 episodes. CAC was low; 54% had no CAC, 25% had scores from 0 to 10, and 21% had CAC ≥10 Agatston score. After adjusting for CVD risk factors, women with ≥3 episodes were twice as likely to have significant CAC (≥10 Agatston units) than women with no depressive episodes (odds ratio 2.20, 95% confidence interval 1.13 to 4.28, p = 0.020) with no difference by race. Women with 1 or 2 episodes did not differ from women with no episodes. In conclusion, in healthy women aged 46 to 59 years without clinical CVD or diabetes, persistent depressive symptoms were significantly associated with elevated CAC scores, suggesting that they are more likely to have pathophysiological and behavioral effects on the development of subclinical CVD than does a single episode of elevated depressive symptoms.
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