Depression may not be an independent risk factor for mortality in patients with cardiovascular disease: data from
Bao The Nguyen1,2, Yi-Chang Li2, Hoang Nhat Dang3
1Hue University of Medicine and Pharmacy, Hue, Viet Nam.
Insights
Depression is not an independent risk factor for mortality in cardiovascular disease (CVD) patients. Rigorous analysis controlling for confounders found no significant association between depressive symptoms and increased mortality risk in this population.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading global cause of death.
- Depression is common in CVD patients and previously considered an independent mortality risk factor.
- Recent research suggests confounding factors may influence the depression-mortality link in CVD.
Purpose of the Study:
- To investigate the association between clinically significant depressive symptoms and mortality risk in adults with CVD.
- To differentiate between all-cause, cardiovascular, and non-cardiovascular mortality in relation to depression.
- To assess if depression remains an independent risk factor after accounting for confounding variables.
Main Methods:
- Secondary analysis of 2064 adults with CVD history from the National Health and Nutrition Examination Survey (2011-2018).
- Depression assessed using Patient Health Questionnaire-9 (PHQ-9) with a threshold of ≥10.
- Multivariable Cox regression, propensity score matching, and inverse probability weighting used to control for confounders.
Main Results:
- Over 4.67 years median follow-up, 403 deaths occurred.
- Initial analysis showed depression linked to higher all-cause and non-cardiovascular mortality (HR 1.33 and 1.46, respectively).
- After propensity score matching and inverse probability weighting, these associations were not statistically significant.
Conclusions:
- Depression is not an independent predictor of mortality in individuals with cardiovascular disease.
- Rigorous adjustment for confounders and comorbidities negates the previously observed association.
- Findings highlight the importance of accounting for confounding factors in CVD and depression research.
Background:
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, while depression is highly prevalent in this patient population and has long been regarded as an independent risk factor for increased mortality. However, recent evidence suggests that this association may be influenced by symptom overlap and residual confounding that has not been fully accounted for.
Objectives:
This study aimed to evaluate the association between clinically significant depressive symptoms and the risk of all-cause, cardiovascular and non-cardiovascular mortality in adults with CVD.
Methods:
We conducted a secondary analysis of 2064 adults with a history of CVD using data from the National Health and Nutrition Examination Survey 2011-2018 linked with the National Death Index. Depression was defined using the Patient Health Questionnaire-9 with a cut-off score of 10 or higher. Primary outcomes were all-cause, cardiovascular and non-cardiovascular mortality. Statistical analyses were performed using R software. We employed multivariable Cox regression models as well as propensity score matching and inverse probability weighting to control for potential confounders.
Results:
Over a median follow-up of 4.67 years, 403 deaths were recorded. In an adjusted multivariable Cox model controlling for age, sex and race, depression was associated with an increased risk of all-cause mortality (HR 1.33; 95% CI 1.02 to 1.75) and non-cardiovascular mortality (HR 1.46; 95% CI 1.04 to 2.05). However, after applying propensity score matching and inverse probability weighting, these associations were no longer statistically significant for any mortality outcome.
Conclusions:
After rigorous adjustment for confounders and comorbidities, depression was no longer identified as an independent risk factor for mortality among patients with CVD.
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