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Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.

TitleElucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsMoise, N, Khodneva, Y, Richman, J, Shimbo, D, Kronish, I, Safford, MM
JournalJ Am Heart Assoc
Volume5
Issue8
Date Published2016 Aug 12
ISSN2047-9980
Abstract

BACKGROUND: Depression is a relapsing and remitting disease. Prior studies on the association between depressive symptoms and incident cardiovascular disease (CVD) have been limited by single measurements, and few if any have examined both incident coronary heart disease and stroke in a large biracial national cohort. We aimed to assess whether time-dependent depressive symptoms conferred increased risk of incident CVD.METHODS AND RESULTS: Between 2003 to 2007, 22 666 black and white participants (aged ≥45 years) without baseline CVD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were recruited. Cox proportional hazards regression analyses assessed the association between up to 3 measurements of elevated depressive symptoms (4-item Center for Epidemiologic Studies Depression Scale score ≥4) and incident coronary heart disease, stroke, and CVD death adjusting for age, sex, region, income, health insurance, education, blood pressure, cholesterol, medication, obesity, diabetes mellitus, kidney disease, C-reactive protein, corrected QT interval, atrial fibrillation, left ventricular hypertrophy, smoking, alcohol, physical inactivity, medication adherence, and antidepressant use. The participants' average age was 63.4 years, 58.8% were female, and 41.7% black. Time-varying depressive symptoms were significantly associated with CVD death (adjusted hazard ratio 1.30, 95% CI 1.04-1.63), with a trend toward significance for fatal and nonfatal stroke (adjusted hazard ratio 1.26, 95% CI 0.99-1.60) but not fatal and nonfatal coronary heart disease (adjusted hazard ratio 1.11, 95% CI 0.89-1.38). Race did not moderate the association between depressive symptoms and CVD.CONCLUSIONS: Proximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.

DOI10.1161/JAHA.116.003767
Alternate JournalJ Am Heart Assoc
PubMed ID27521153
PubMed Central IDPMC5015296
Grant ListK24 HL111154 / HL / NHLBI NIH HHS / United States
P30 DK079626 / DK / NIDDK NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
R01 HL114924 / HL / NHLBI NIH HHS / United States
R01 HL080477 / HL / NHLBI NIH HHS / United States
K24 HL125704 / HL / NHLBI NIH HHS / United States