Depressive Symptoms Prior to and after Incident Cardiovascular Disease and Long-term Survival A population-based Study of Older Persons

Background: Depression after a CVD event is associated with increased mortality. However, little is known about how pre-existing depression affects survival after CVD incidence. Aim: To evaluate whether depressive symptoms measured preceding first incident CVD (pre-CVD), as well as measured after CVD (post-CVD), affect survival. Methods: From the Rotterdam Study, 6,932 persons aged 55+ and free of dementia and CVD completed the Center for Epidemiological Studies Depression (CES-D) scale every 4 to 5 years from 1993. CES-D subdomains were positive affect, negative affect, somatic symptoms and interpersonal affect. Persons were followed for mortality and CVD, defined as incident stroke, heart failure and coronary heart disease (CHD). Results: During 15-year follow-up, 22% of participants suffered their first incident CVD. Depressive symptoms measured ≈3 years prior to first incident CVD were not associated with mortality after adjustment for smoking status and physical function (HR per 10-point score: 1.04, 95%CI: 0.97-1.10). Higher pre-CHD somatic symptoms were associated with greater CHD mortality and higher pre-stroke positive affect was associated with less stroke mortality. After first incident CVD, depressive symptoms increased. Higher depressive symptoms measured after CVD was associated with an increased risk for mortality (HR: 1.09, 95%CI: 1.00, 1.19). Higher post-CVD positive affect was protective of both all-cause and CVD mortality. Conclusion: During 15-years follow-up in community-dwelling older adults, the relation between higher depressive symptoms measured before first incident CVD and mortality was not independent of health status. In contrast, higher depressive symptoms measured after CVD was associated with an increased risk for mortality.