The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease

Figures

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  Figure 1. Participant Selection Participant selection for analyses evaluating the impact of baseline, year-1, and change in depressive symptoms or status on CV death or MI. We excluded individuals with baseline depression assessments who did not complete follow-up depression assessments or had CV death or MI before follow-up from analyses evaluating the impact of year 1 and change depression or depressive symptoms on CV death or MI.

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  Figure 2. MACE Cumulative Incidence Curves by Depression Status Kaplan–Meier unadjusted cumulative incidence curves of participants with depression (PHQ8 >9, grey) and no depression (PHQ8 ≤9, blue) at enrollment (A) and year 1 follow-up (B). Significant differences are denoted by log-rank P < 0.05. PHQ8 = Patient Health Questionnaire 8.

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  Figure 3. sHR of Depressive Symptoms on MACE Ratios for baseline, year 1, and change in depressive symptoms (Δ PHQ8) were assessed by Fine and Gray models with the composite of CV death or MI as the event of interest and non-CV death as the competing event. Model 1 is the univariate model, model 2 is adjusted for demographics, model 3 is adjusted for model 2 covariates and cardiovascular risk factors, and model 4 is adjusted for model 3 covariates and depression risk factors. PHQ8 = Patient Health Questionnaire 8; sHR = subdistribution HR.

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  Figure 4. Interaction Between ΔPHQ8 and Covariates on MACE Pooled interaction effects between change in depressive symptoms (ΔPHQ8) and listed covariates on CV death or MI. Pooled forest plots showing adjusted log effect sizes of change in depressive symptoms (ΔPHQ8) on CV death or MI by subgroup strata, which were calculated by Cox proportional hazards models adjusted for demographics, cardiovascular risk factors, and depression risk factors. Significant interactions have P for interaction<0.05. PHQ8 = Patient Health Questionnaire 8.

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  Central Illustration. The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease Persistent depression is associated with MACE. Kaplan–Meier unadjusted cumulative incidence curves show a significantly higher incidence of MACE among those with persistent depression (gold) or new depression (black) versus those with remitted depression (red) or never depression (blue).