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Chin K. Kim, MD; Susan P. McGorray, PhD; Beth A. Bartholomew, MD; Michelle Marsh, RN; Tammy Dicken, LPN; Sylvia Wassertheil-Smoller, PhD; J. David Curb, MD; Albert Oberman, MD, MPH; Judith Hsia, MD; Julius Gardin, MD; Nathan D. Wong, PhD; Bruce Barton, PhD; Robert P. McMahon, PhD; David S. Sheps, MD, MSPH

Arch Intern Med. 2005;165:1239-1244.

Background  Depressive symptoms have been associated with increased cardiac morbidity and mortality rates, but the pathophysiologic mechanism linking depressive symptoms to cardiovascular outcome has yet to be fully understood. Lower heart rate variability has also been associated with increased risk of cardiac events in healthy individuals and in patients with coronary artery disease. Findings regarding a relationship between depressive symptoms and heart rate variability that could explain increased cardiovascular risk have been inconsistent across studies.

Methods  As an ancillary study to the Women's Health Initiative Observational Study, 3372 postmenopausal women aged 50 to 83 years were enrolled for further evaluation using 24-hour ambulatory electrocardiographic monitoring. A shortened version of the Center for Epidemiological Studies Depression Scale and the Diagnostic Interview Schedule were administered. Women with adequate electrocardiographic data and depressive symptom information and without coronary artery disease were analyzed (n = 2627).

Results  Two hundred sixty-nine women (10.2%) had depressive symptoms as measured using the 2 instruments. Women with depressive symptoms had a higher mean ± SD heart rate (77.4 ± 9.6 vs 75.5 ± 8.5 beats/min) and lower heart rate variability than women without depressive symptoms. All differences remained significant after adjusting for age (P<.01).

Conclusions  Women with depressive symptoms had significant reductions in heart rate variability and higher heart rates, suggestive of increased sympathetic tone. These findings may contribute to the increased cardiac morbidity and mortality rates associated with depression in other studies.

Author Affiliations: Division of Cardiovascular Medicine (Drs Kim and Sheps and Mss Marsh and Dicken) and Department of Statistics (Dr McGorray), University of Florida, Gainesville; William Beaumont Hospital, Royal Oak, Mich (Dr Bartholomew); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY (Dr Wassertheil-Smoller); Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa (Dr Curb); Department of Medicine, University of Alabama at Birmingham (Dr Oberman); Department of Medicine, George Washington Medical Center, Washington, DC (Dr Hsia); Department of Medicine, St Johns Hospital, Detroit, Mich (Dr Gardin); Heart Disease Prevention Program, University of California, Irvine (Dr Wong); Maryland Medical Research Institute, Baltimore (Dr Barton); Maryland Psychiatric Research Center, Catonsville (Dr McMahon); Research Service, Veterans Affairs Medical Center, Gainesville (Ms Marsh and Dr Sheps); and The Heart Center, Kingsport, Tenn (Ms Dicken).

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