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Depression and Risk of Heart Failure Among Older Persons With Isolated Systolic Hypertension
Jerome Abramson, PhD;
Alan Berger, MD;
Harlan M. Krumholz, MD, MPH;
Viola Vaccarino, MD, PhD
Arch Intern Med. 2001;161:1725-1730.
Background Investigators have shown that depression is associated with an increased
risk of coronary heart disease in general and myocardial infarction in particular.
However, it is unknown whether depression, independent of its association
with myocardial infarction, is a risk factor for heart failure.
Methods This study examined whether depression was a predictor of incident heart
failure among 4538 persons aged 60 years and older with isolated systolic
hypertension who were enrolled in the Systolic Hypertension in the Elderly
Program (SHEP). Depression was defined as a score of 16 or more at baseline
on the Center for Epidemiological Studies Depression Scale (CES-D). The relationship
between depression and heart failure was assessed using Cox proportional hazards
regression.
Results The average follow-up was 4.5 years. Heart failure developed in 138
(3.2%) of 4317 nondepressed persons and in 18 (8.1%) of 221 depressed persons.
After controlling for age; sex; race; history of myocardial infarction, diabetes,
or angina; blood pressure; cholesterol levels; electrocardiographic abnormalities;
smoking; disability; and SHEP treatment group, depressed persons had more
than a 2-fold higher risk of developing heart failure compared with nondepressed
persons (hazard ratio, 2.59; 95% confidence interval, 1.57-4.27; P<.001). After additional adjustment for the occurrence of myocardial
infarction during follow-up, depressed persons remained at elevated risk of
heart failure (hazard ratio, 2.82; 95% confidence interval, 1.71-4.67; P<.001).
Conclusions Depression is independently associated with a substantial increase in
the risk of heart failure among older persons with isolated systolic hypertension.
This association does not appear to be mediated by myocardial infarction.
From the Department of Medicine, Division of Cardiology, Emory University
School of Medicine, Atlanta, Ga (Drs Abramson and Vaccarino); Division of
Cardiology and Epidemiology, University of Minnesota, Minneapolis (Dr Berger);
and Department of Epidemiology and Public Health and Section of Cardiovascular
Medicine, Yale University School of Medicine, New Haven, Conn (Dr Krumholz).
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