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Coronary and Aortic Calcification in Women With a History of Major Depression
Patricia K. Agatisa, PhD;
Karen A. Matthews, PhD;
Joyce T. Bromberger, PhD;
Daniel Edmundowicz, MD;
Yue-Fang Chang, PhD;
Kim Sutton-Tyrrell, DrPH
Arch Intern Med. 2005;165:1229-1236.
Background Although depression is a well-documented risk factor for clinical heart disease, its association with subclinical atherosclerosis is unclear. We hypothesized that middle-aged women with a history of recurrent major depression would show evidence of atherosclerosis.
Methods Coronary and aortic calcification was measured by electron beam tomography in 58 African American and 152 white healthy middle-aged women. Women were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and a self-report measure of current depressive symptoms.
Results Coronary calcification was found in 103 women (49%) and aorta calcification in 144 women (54%); high calcification scores were set at approximately 75% of the sample distribution (ie, at  10 for the coronary calcium score [n = 49 women] and at >100 for the aorta calcium score [n = 53 women]). Women with a history of recurrent major depression (n = 53) were more likely to have any coronary calcification or calcification in the high category at either site compared with women with a history of a single episode of depression or no depression. After stepwise forward adjustment for cardiovascular risk factors and sociodemographic characteristics, a history of recurrent major depression, compared with a single episode or no history, was associated with odds ratios (ORs) of 2.46 (95% confidence interval [CI], 1.06-5.67) for any coronary calcification, 2.71 (95% CI, 1.08-6.81) for high coronary calcification, and 3.39 (95% CI, 1.34-8.63) for high aortic calcification. Further adjustments for waist-hip ratio reduced the association between history of recurrent depression and any calcification (OR, 2.24; 95% CI, 0.94-5.32) and high calcification (OR, 2.31; 95% CI, 0.89-5.99).
Conclusions In this sample of asymptomatic middle-aged women without known coronary disease, recurrent major depression was independently associated with coronary and aortic calcification. Waist-hip ratio in part mediated the association. Our findings suggest that recurrent major depression may be a risk factor for early atherosclerosis in women.
Author Affiliations: Department of Psychiatry (Drs Agatisa and Matthews), Division of Cardiology (Dr Edmundowicz), and Department of Neurosurgery (Dr Chang) School of Medicine, and Department of Epidemiology, Graduate School of Public Health (Drs Bromberger and Sutton-Tyrrell), University of Pittsburgh, Pittsburgh, Pa.
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