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Association between depressive symptoms and incident cardiovascular diseases

Association between depressive symptoms and incident cardiovascular diseases
Association between depressive symptoms and incident cardiovascular diseases
Importance It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs).

Objective To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.

Design, Setting, and Participants A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline.

Exposures Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder).

Main Outcomes and Measures Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported.

Results Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors.

Conclusions and Relevance In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.
0098-7484
2396-2405
Harshfield, Eric L.
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Pennells, Lisa
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Schwartz, Joseph E.
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Willeit, Peter
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Kaptoge, Stephen K.
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Bell, Steven
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Shaffer, Jonathan A
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Bolton, Thomas
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Spackman, Sarah
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Wassertheil-Smoller, Sylvia
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Kee, Frank
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Amouyel, Philippe
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Shea, Steven J
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Kuller, Lewis H.
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Kauhanen, Jussi
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Blazer, Dan G.
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Kromhout, Daan
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Laughlin, Gail
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Berkman, Lisa
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Wallace, Robert B
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Simons, Leon A
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Dennison, Elaine
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Barr, Elizabeth L M
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Meyer, Haakon E
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Wood, Angela M.
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Danesh, John
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Di Angelantonio, Emanuele
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Davidson, Karina W
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Harshfield, Eric L.
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Pennells, Lisa
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Schwartz, Joseph E.
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Willeit, Peter
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Kaptoge, Stephen K.
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Bell, Steven
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Shaffer, Jonathan A
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Bolton, Thomas
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Spackman, Sarah
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Wassertheil-Smoller, Sylvia
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Kee, Frank
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Amouyel, Philippe
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Shea, Steven J
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Kuller, Lewis H.
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Kauhanen, Jussi
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Blazer, Dan G.
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Krumholz, Harlan
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Nietert, Paul J
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Kromhout, Daan
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Laughlin, Gail
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Berkman, Lisa
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Wallace, Robert B
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Simons, Leon A
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Dennison, Elaine
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Barr, Elizabeth L M
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Meyer, Haakon E
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Wood, Angela M.
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Danesh, John
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Di Angelantonio, Emanuele
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Davidson, Karina W
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Harshfield, Eric L., Pennells, Lisa, Schwartz, Joseph E., Willeit, Peter, Kaptoge, Stephen K., Bell, Steven, Shaffer, Jonathan A, Bolton, Thomas, Spackman, Sarah, Wassertheil-Smoller, Sylvia, Kee, Frank, Amouyel, Philippe, Shea, Steven J, Kuller, Lewis H., Kauhanen, Jussi, E M van Zutphen, E M, Blazer, Dan G., Krumholz, Harlan, Nietert, Paul J, Kromhout, Daan, Laughlin, Gail, Berkman, Lisa, Wallace, Robert B, Simons, Leon A, Dennison, Elaine, Barr, Elizabeth L M, Meyer, Haakon E, Wood, Angela M., Danesh, John, Di Angelantonio, Emanuele and Davidson, Karina W (2020) Association between depressive symptoms and incident cardiovascular diseases. Journal of the American Medical Association, 324 (23), 2396-2405. (doi:10.1001/jama.2020.23068).

Record type: Article

Abstract

Importance It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs).

Objective To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.

Design, Setting, and Participants A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline.

Exposures Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder).

Main Outcomes and Measures Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported.

Results Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors.

Conclusions and Relevance In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.

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More information

Accepted/In Press date: 1 December 2020
e-pub ahead of print date: 15 December 2020

Identifiers

Local EPrints ID: 446906
URI: http://eprints.soton.ac.uk/id/eprint/446906
ISSN: 0098-7484
PURE UUID: 977d8e2c-d5c8-4f39-9e7b-4b796d869208
ORCID for Elaine Dennison: ORCID iD orcid.org/0000-0002-3048-4961

Catalogue record

Date deposited: 26 Feb 2021 17:30
Last modified: 23 Nov 2022 02:34

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Contributors

Author: Eric L. Harshfield
Author: Lisa Pennells
Author: Joseph E. Schwartz
Author: Peter Willeit
Author: Stephen K. Kaptoge
Author: Steven Bell
Author: Jonathan A Shaffer
Author: Thomas Bolton
Author: Sarah Spackman
Author: Sylvia Wassertheil-Smoller
Author: Frank Kee
Author: Philippe Amouyel
Author: Steven J Shea
Author: Lewis H. Kuller
Author: Jussi Kauhanen
Author: E M E M van Zutphen
Author: Dan G. Blazer
Author: Harlan Krumholz
Author: Paul J Nietert
Author: Daan Kromhout
Author: Gail Laughlin
Author: Lisa Berkman
Author: Robert B Wallace
Author: Leon A Simons
Author: Elaine Dennison ORCID iD
Author: Elizabeth L M Barr
Author: Haakon E Meyer
Author: Angela M. Wood
Author: John Danesh
Author: Emanuele Di Angelantonio
Author: Karina W Davidson

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