MONTREAL — In women with documented cardiovascular risk factors, those with comorbid depression have a greater risk of clinical events, compared with their nondepressed counterparts, according to new findings from the Women's Ischemic Syndrome Evaluation (WISE), trial sponsored by the National Heart, Lung, and Blood Institute.
“Many studies have associated depression with an increased risk of cardiovascular disease incidence, but until now, the predictive value of these risk factors has been unknown,” reported Thomas Rutledge, Ph.D., of the department of psychiatry at the University of California, San Diego.
“We wanted to know whether the added presence of depression would statistically worsen the relationship between cardiac risk factors and outcome,” he explained at the annual meeting of the Society of Behavioral Medicine.
Dr. Rutledge examined the association of cardiovascular disease (CVD) risk factors with actual CVD events in 153 depressed and 718 nondepressed women who were enrolled in the WISE trial. The women were a mean age of 60 years and all of them had been referred for coronary angiography because of symptoms suggestive of myocardial ischemia.
CVD risk factors were assessed, including smoking, dyslipidemia, hypertension, obesity, diabetes, and level of physical activity.
Depression was defined as self-reported current use of antidepressants to treat depression.
Over a mean follow-up period of 5.9 years, the CVD mortality rate was higher in depressed women with CVD risk factors than it was in nondepressed women with the same risk factors (11.5% vs. 9.2%, respectively). Similarly, depressed women experienced more cardiovascular events such as stroke, myocardial infarction, and heart failure (23.9% vs. 13.3%).
For four of the six individual CVD risk factors, “the combination of depression and the risk factor was associated with a significantly worse event rate, compared with the risk factor alone,” said Dr. Rutledge. “The exceptions were smoking and diabetes, but these were the two risk factors for which we had the smallest sample size, so power was possibly an issue.”
Excluding these exceptions, the combination of depression and risk factors was associated with an average 12%-13% increase in death and events, compared with risk factors alone, he said.