Cardiovascular risk assessment in male and female patients with and without depression: an electronic health record evaluation in Wales

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.