February 22, 2022Journal of the American Heart AssociationOpen Access

Depressive Symptoms and Incident Heart Failure in the Jackson Heart Study: Differential Risk Among Black Men and Women

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Why the study?

Associations between depression, incident HF, and mortality are well documented in predominantly White samples, but data from racial minorities, particularly women, are sparse, and depression is underrecognized and undertreated in the Black population.

Do clinically significant depressive symptoms increase the risk of incident heart failure and all-cause mortality in Black adults without a history of heart failure?

Structured PICO

Do clinically significant depressive symptoms increase the risk of incident heart failure and all-cause mortality in Black adults without a history of heart failure?

Population

2,651 Black adults from the Jackson Heart Study with no history of heart failure at baseline, median age 53 years, 63.9% women.

Intervention

Clinically significant depressive symptoms at baseline (Center for Epidemiological Studies-Depression scores ≥16)

Comparator

Low depressive symptoms at baseline (Center for Epidemiological Studies-Depression scores <16)

Outcome

Incident heart failure across 10 yearshard clinical

Clinically significant depressive symptoms are associated with a 53% increased risk of incident heart failure in Black women, highlighting the need for sex-specific management of depression to improve cardiovascular outcomes.

Implication

Supports sex-specific depression monitoring in Black women; extends prior associations but leaves open causal effects on HF.

Abstract

Background Associations between depression, incident heart failure (HF), and mortality are well documented in predominately White samples. Yet, there are sparse data from racial minorities, including those who are women, and depression is underrecognized and undertreated in the Black population. Thus, we examined associations between baseline depressive symptoms, incident HF, and all‐cause mortality across 10 years. Methods and Results We included Jackson Heart Study (JHS) participants with no history of HF at baseline (n=2651; 63.9% women; median age, 53 years). Cox proportional hazards models tested if the risk of incident HF or mortality differed by clinically significant depressive symptoms at baseline (Center for Epidemiological Studies–Depression scores ≥16 versus <16). Models were conducted in the full sample and by sex, with hierarchical adjustment for demographics, HF risk factors, and lifestyle factors. Overall, 538 adults (20.3%) reported high depressive symptoms (71.0% were women), and there were 181 cases of HF (cumulative incidence, 0.06%). In the unadjusted model, individuals with high depressive symptoms had a 43% greater risk of HF ( P =0.035). The association remained with demographic and HF risk factors but was attenuated by lifestyle factors. All‐cause mortality was similar regardless of depressive symptoms. By sex, the unadjusted association between depressive symptoms and HF remained for women only ( P =0.039). The fully adjusted model showed a 53% greater risk of HF for women with high depressive symptoms ( P =0.043). Conclusions Among Black adults, there were sex‐specific associations between depressive symptoms and incident HF, with greater risk among women. Sex‐specific management of depression may be needed to improve cardiovascular outcomes.