The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease
Nishant Vatsa1, Josiah Bennett2, Sonika Vatsa3
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Increasing or persistent depression significantly predicts major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD). Monitoring depression changes is crucial for cardiovascular risk assessment in CHD patients.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depression is a known risk factor for major adverse cardiovascular events (MACE).
- The impact of longitudinal changes in depression on MACE in coronary heart disease (CHD) patients is not well understood.
- This study investigates the relationship between evolving depressive symptoms and cardiovascular outcomes in individuals with CHD.
Purpose of the Study:
- To test the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.
- To analyze how changes in depressive symptom scores over time correlate with the incidence of MACE.
- To identify specific depression trajectories associated with increased cardiovascular risk.
Main Methods:
- Utilized data from the Emory Cardiovascular Biobank, including 3,483 participants initially assessed for depression using the Patient Health Questionnaire 8 (PHQ8).
- Follow-up questionnaires at 1 year assessed changes in depressive symptoms, categorizing participants into 'never depression,' 'new depression,' 'remitted depression,' and 'persistent depression' groups.
- Fine-Gray competing risk models were employed to evaluate the association between depression changes and MACE, adjusting for relevant covariates.
Main Results:
- A total of 2,639 participants completed the 1-year follow-up. The overall incidence of MACE was 14%.
- Increasing depressive symptoms, as measured by PHQ8, independently predicted MACE (subdistribution HR: 1.06).
- Persistent depression (20.8%) and new depression (11.9%) were associated with significantly higher MACE incidence compared to never depression (8%). Persistent depression showed a strong independent prediction for MACE (subdistribution HR: 2.78).
Conclusions:
- The study concludes that both increasing and persistent depression are significant predictors of MACE in individuals with CHD.
- These findings underscore the importance of monitoring and managing depression in patients with coronary heart disease to mitigate cardiovascular risk.
- Longitudinal assessment of depressive symptoms provides valuable prognostic information for cardiovascular events in CHD patients.
Background:
Depression is associated with major adverse cardiovascular events (MACE). Whether longitudinal changes in depression affect MACE in patients with coronary heart disease (CHD) remains unknown.
Objectives:
The authors evaluated the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.
Methods:
At baseline, 3,483 Emory Cardiovascular Biobank participants (median age 65.5 years, 31.6% female) completed the Patient Health Questionnaire 8 (PHQ8) for depression evaluation. At 1 year, 2,639 of these event-free participants repeated the questionnaire. Depression was defined as a PHQ8 score >9 and change in depressive symptoms ( PHQ8) was year 1 score minus baseline PHQ8 scores. We categorized participants into never depression (both PHQ8 <10), new depression (baseline PHQ8 <10; 1-year PHQ8 >9), remitted depression (baseline PHQ8 >9; year 1 PHQ8 <10), and persistent depression (both PHQ8 >9) groups. Fine-Gray models with noncardiovascular death as the competing event and adjusted for demographics, CHD, and depression related factors evaluated how changes in depression affect MACE (cardiovascular death and MI).
Results:
Overall, the incidence of MACE was 14%, with 8.7% of those with follow-up PHQ8 having MACE. 2.9% had persistent depression, 4.5% had new depression, 10.8% had remitted depression, and 81.8% never had depression. Increasing depressive symptoms independently predicted MACE ( PHQ8 subdistribution HR: 1.06 [95% CI: 1.02-1.09], P < 0.001). Correspondingly, the incidence of MACE was higher in those with persistent (20.8%) or new depression (11.9%) than in those with remitted (9.4%) or never depression (8%) (P < 0.001). Compared to never depression, persistent depression independently predicted MACE (subdistribution HR: 2.78 [95% CI: 1.2-6.5], P = 0.017).
Conclusions:
Increasing or persistent depression predicts MACE in individuals with CHD.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:18Depression: Overview
01:27Depressive Disorders: MDD and Dysthymia
01:27Depressive Disorders: Etiology
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
01:03Long-term Depression
Calcium Ion Concentration Mechanism
If over...
01:25Antidepressant Drugs: Overview