Multiple Depressive Symptoms Increases Risk of Cardiovascular Disease

June 17, 2020
Selina Rajan, MSc

Selina Rajan, MSc

The number of depressive symptoms could help forecast the risk of negative outcomes from cardiovascular disease.

A team, led by Selina Rajan, MSc, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, examined whether the increased risk of incident cardiovascular disease and mortality in middle-aged adults with depressive symptoms could vary across different countries or within the same country.

Depression can be linked to incidence of cardiovascular disease and cancer, as well as premature death in high-income countries. However, it is not known whether this association is also true in low-to-moderate income countries and in urban areas, which are known to have more people living with depression.

In the cohort study, the investigators examined data from 145,862 individuals in 21 economic diverse countries on 56 continents between January 2005 and June 2019 with a median follow-up of 9.3 years. The multicenter, population-based cohort included 370 urban and 314 rural communities.

Countries and communities were selected to reflect socioeconomically diverse populations, with broadly representative samples of each community. 

The investigators used data from the Prospective Urban Rural Epidemiological (PURE) study, with standardized information on baseline depression and physical health outcomes.

The investigators enrolled eligible patients between 35-70 years old, with a mean age of 50.05 years with no intention to change addresses within 4 years. A total of 15,983 (11%) of participants reported 4 or more depressive symptoms at baseline.

The main outcomes were incident cardiovascular disease, all-cause mortality, and a combined measure of either incident cardiovascular disease or all-cause mortality.

Depression was linked to incident cardiovascular disease (HR, 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.23; 95% CI, 1.11-1.25), the combined cardiovascular disease and all-cause mortality outcome (HR, 1.18; 95% 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and non-cardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models.

The risk of the combined outcome increased along with the number of symptoms, with the risk highest in patients with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest in individuals with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). 

The team found cardiovascular events and death increased by 20% in people with 4 or more depressive symptoms compared to individuals without depressive symptoms. The relative risk of cardiovascular events and death increased in countries at all economic levels, but was more than twice as high in urban areas (HR, 1.23; 95% CI, 1.13-1.34) than it was in rural areas (HR, 1.10; 95% CI, 1.02-1.19; P for interaction = .001).

The risk was also higher in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001).

“In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas,” the authors wrote. “Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.”

The study, “Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries,” was published online in JAMA Psychiatry.
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