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Cardiovascular Risk Assessment in Male and Female Patients With and Without Depression: an Electronic Health Record
Elizabeth A Ellins1, Richard Summers1, Ann John1
1Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea.SA2 8PP, UK.
Insights
Patients with depression receive more frequent cardiovascular risk factor assessments, including blood pressure, lipid levels, and QRISK scores, compared to those without depression. Sex and age significantly influence these assessments, highlighting areas for improved cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Mental Health Research
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Depression is increasingly recognized as a significant risk factor for CVD.
- Effective primary prevention of CVD relies on regular assessment of key risk factors.
Purpose of the Study:
- To compare the rates of cardiovascular risk factor assessment in patients with and without depression.
- To investigate the influence of depression status on the documentation of blood pressure, lipid levels, and QRISK scores.
- To explore potential sex and age interactions in cardiovascular risk assessment among patients with and without depression.
Main Methods:
- Retrospective observational cohort study utilizing electronic health records.
- Analysis of blood pressure measurement, lipid checks, and QRISK score documentation rates.
- Poisson regression adjusted for age and sex to determine associations between depression and assessment rates.
Main Results:
- Patients with depression showed higher rates of blood pressure, lipid, and QRISK score documentation compared to non-depressed patients, after adjustment for age and sex.
- Significant sex differences were observed, with younger females more likely to have blood pressure checked and males more likely to have lipid levels checked.
- Complex interactions between depression status, sex, and age group influenced the assessment rates for all cardiovascular risk factors.
Conclusions:
- Depression is associated with more frequent cardiovascular risk factor assessment in primary care.
- Observed sex and age disparities in risk factor assessment may affect cardiovascular risk management.
- Opportunities exist to optimize CVD primary prevention strategies by addressing these assessment variations.
Aim:
To investigate rates of cardiovascular risk factor assessment (blood pressure, lipid and QRISK score) in routine clinical practice for primary prevention of cardiovascular disease (CVD) in patients with and without depression.
Methods:
A retrospective observational cohort study using electronic health record data sources was carried out. Rates of blood pressure measurement, lipid checks and QRISK documentation in primary care were calculated for non-depressed, and patients prior and subsequent to depression diagnosis. Poisson regression adjusting for age and sex was used to explore associations between depression status and rate of assessment. Differences in rates of assessment by deprivation and location of residence (urban/rural) were also explored.
Results:
Of 2,290,075 patients, 176,062 had depression diagnosed. Patients with depression had blood pressure and lipid levels checked and QRISK score documented more frequently, after adjustment for sex and age group. Sex differences were noted, with younger females more likely to have blood pressure assessment and males more likely to have lipid levels checked, irrespective of depression status. There were significant three-way interactions between depression*sex*age group for all outcomes, with sex difference in blood pressure assessment highly dependent on age, and sex/depression status difference in lipid assessment most notable in the 60-74 age group.
Conclusion:
Patients with depression are more likely to have their blood pressure, lipid levels and QRISK documented than patients without depression. Sex differences in assessment of blood pressure and lipid assessments may also impact on future cardiovascular risk management, providing opportunities for potential improvements in assessment of risk factors.
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