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Depression and Cardiovascular Sequelae in Postmenopausal Women
The Women's Health Initiative (WHI)
Sylvia Wassertheil-Smoller, PhD;
Sally Shumaker, PhD;
Judith Ockene, PhD;
Greg A. Talavera, MD, MPH;
Philip Greenland, MD;
Barbara Cochrane, RN, PhD;
John Robbins, MD;
Aaron Aragaki, MS;
Jacqueline Dunbar-Jacob, PhD, RN
Arch Intern Med. 2004;164:289-298.
Background Subclinical depression, often clinically unrecognized, may pose increased risk of cardiovascular disease. Few studies have prospectively investigated cardiovascular events related to depression in older women. We describe prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women.
Methods The Women's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years. Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale. Risks of cardiovascular disease (CVD) events were estimated from Cox proportional hazards models adjusting for multiple demographic, clinical, and risk factor covariates.
Results Current depressive symptoms above the screening cutoff point were reported by 15.8% of women. Depression was significantly related to CVD risk and comorbidity (odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina). Among women with no history of CVD, depression was an independent predictor of CVD death (relative risk, 1.50) and all-cause mortality (relative risk, 1.32) after adjustment for age, race, education, income, diabetes, hypertension, smoking, high cholesterol level requiring medication, body mass index, and physical activity. Taking antidepressant medications did not alter the depression-associated risks associated.
Conclusions A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality, even after controlling for established CVD risk factors. Whether early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.
From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Dr Wassertheil-Smoller); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Shumaker); Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester (Dr Ockene); Division of Health Promotions and Behavioral Sciences, San Diego State University, San Diego, Calif (Dr Talavera); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Greenland); Department of Cancer Prevention Research (Dr Cochrane), Public Health Sciences Division (Mr Aragaki), Fred Hutchinson Cancer Research Center, Seattle, Wash; Department of Internal Medicine, University of California, Davis (Dr Robbins); and School of Nursing, University of Pittsburgh, Pittsburgh, Pa (Dr Dunbar-Jacob). Dr Shumaker is a consultant for Wyeth Pharmaceuticals and Pfizer Pharmaceuticals and is a principal investigator on research funded by them.
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