Stable high depressive symptoms (HR 2.14; 95% CI 1.69-2.71) and remitted depressive symptoms (HR 1.66; 95% CI 1.22-2.26) were associated with an increased risk of incident stroke compared with stable low/no symptoms.
Cohort (n=16,178)
Do dynamic patterns of depressive symptoms (stable high, onset, or remitted) predict incident stroke in middle-aged and older adults?
Persistently high and remitted depressive symptoms are associated with an increased risk of incident stroke, suggesting cumulative etiologic mechanisms linking depression and stroke.
Effect estimate: HR 2.14 (95% CI 1.69 to 2.71)
BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67). CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.
Gilsanz et al. (Fri,) conducted a cohort in Depressive symptoms and stroke (n=16,178). Stable high or remitted depressive symptoms vs. Stable low/no depressive symptoms was evaluated on Incident stroke (HR 2.14, 95% CI 1.69 to 2.71). Stable high depressive symptoms (HR 2.14; 95% CI 1.69-2.71) and remitted depressive symptoms (HR 1.66; 95% CI 1.22-2.26) were associated with an increased risk of incident stroke compared with stable low/no symptoms.