September 1, 2005Psychosomatic Medicine132 citations
View Full PaperDepressive Symptoms, Coronary Heart Disease, and Overall Mortality in the Framingham Heart Study
Key Result
Depressive symptoms were directly associated with all-cause mortality, with a 37% higher risk of death per tertile increment in CES-D score (HR 1.37; 95% CI 1.10-1.71; P=0.005).
Study Design
Type
Cohort (n=3,634)
Structured PICO
Do depressive symptoms predict incident coronary heart disease and all-cause mortality in individuals initially free of heart disease?
P
Population
3,634 community-dwelling adults (mean age 52, 55% women) initially free of heart disease, followed for 6 years.
E
Exposure
Depressive symptoms (measured by Center for Epidemiologic Studies Depression Scale [CES-D] score)
C
Comparator
Lowest tertile of CES-D score
O
Outcome
Incident hard coronary heart disease event (myocardial infarction or coronary death) and all-cause mortality over 6 years of follow-uphard clinical
In a community cohort initially free of heart disease, depressive symptoms were associated with increased all-cause mortality but did not predict incident hard coronary heart disease events.
Main Result
Hazard Ratio: 1.37 (95% CI 1.1–1.71)
p-value: p=0.005
Abstract
OBJECTIVE: Although a substantial number of studies have shown that depressive symptoms predict worse cardiac outcome for patients with existing coronary disease, relatively few methodologically rigorous studies have examined the relation of depressive symptoms to coronary disease incidence in individuals initially free of heart disease in the community. METHODS: Using multivariable-adjusted sex-stratified Cox proportional hazards regression, we examined the association between depressive symptoms and incident coronary disease and all-cause mortality in 3634 Framingham Heart Study original and offspring cohort participants (mean age 52 years, 55% women) attending a routine study examination between 1983 and 1994. RESULTS: Over 6 years of follow-up, 83 participants had a hard coronary heart disease event (myocardial infarction or coronary death), and 133 died. Depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D) > or =16) did not predict hard coronary disease events. All-cause mortality, however, was directly associated with depressive symptoms. Compared with the lowest tertile of CES-D score, multivariable-adjusted risks of death in the second and third tertiles were 33% and 88% higher, respectively (hazards ratio per tertile increment = 1.37, 95% confidence interval 1.10-1.71, p for trend = 0.005). CONCLUSION: These findings underscore the importance of further research into the pathogenesis and prevention of excess mortality experienced with depressive symptoms.