Eric L Harshfield1,2, Lisa Pennells1, Joseph E Schwartz3,4, Peter Willeit1,5, Stephen Kaptoge1, Steven Bell1,2, Jonathan A Shaffer6, Thomas Bolton1, Sarah Spackman1, Sylvia Wassertheil-Smoller7, Frank Kee8, Philippe Amouyel9, Steven J Shea10, Lewis H Kuller11, Jussi Kauhanen12, E M van Zutphen13,14,15, Dan G Blazer16, Harlan Krumholz17, Paul J Nietert18, Daan Kromhout19, Gail Laughlin20, Lisa Berkman21, Robert B Wallace22, Leon A Simons23, Elaine M Dennison24, Elizabeth L M Barr25, Haakon E Meyer26, Angela M Wood1, John Danesh1, Emanuele Di Angelantonio1, Karina W Davidson27. 1. Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. 2. Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom. 3. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York. 4. Applied Behavioral Medicine Research Institute, Stony Brook University, Stony Brook, New York. 5. Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. 6. University of Colorado Denver, Denver. 7. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 8. Centre for Public Health, Queens University, Belfast, United Kingdom. 9. Institut Pasteur de Lille, Lille, France. 10. Columbia Field Center, Columbia University, New York, New York. 11. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania. 12. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland. 13. Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC at VU University Medical Center, Amsterdam, the Netherlands. 14. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC at VU University Medical Center, Amsterdam, the Netherlands. 15. GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands. 16. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina. 17. Yale School of Medicine, New Haven, Connecticut. 18. Department of Public Health Sciences, Medical University of South Carolina. 19. Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. 20. Family Medicine & Public Health, University of California, San Diego. 21. Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 22. Department of Epidemiology, University of Iowa College of Public Health. 23. Faculty of Medicine, UNSW, Sydney, Australia. 24. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom. 25. Baker Heart and Diabetes Institute, Melbourne, Australia. 26. Norwegian Institute of Public Health, Oslo, Norway. 27. Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York.
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.
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.
Authors: Judith H Lichtman; Erika S Froelicher; James A Blumenthal; Robert M Carney; Lynn V Doering; Nancy Frasure-Smith; Kenneth E Freedland; Allan S Jaffe; Erica C Leifheit-Limson; David S Sheps; Viola Vaccarino; Lawson Wulsin Journal: Circulation Date: 2014-02-24 Impact factor: 29.690
Authors: Christoph U Correll; Marco Solmi; Nicola Veronese; Beatrice Bortolato; Stella Rosson; Paolo Santonastaso; Nita Thapa-Chhetri; Michele Fornaro; Davide Gallicchio; Enrico Collantoni; Giorgio Pigato; Angela Favaro; Francesco Monaco; Cristiano Kohler; Davy Vancampfort; Philip B Ward; Fiona Gaughran; André F Carvalho; Brendon Stubbs Journal: World Psychiatry Date: 2017-06 Impact factor: 49.548
Authors: Angelina R Sutin; Antonio Terracciano; Yuri Milaneschi; Yang An; Luigi Ferrucci; Alan B Zonderman Journal: JAMA Psychiatry Date: 2013-08 Impact factor: 21.596
Authors: Marina Daskalopoulou; Julie George; Kate Walters; David P Osborn; G David Batty; Dimitris Stogiannis; Eleni Rapsomaniki; Mar Pujades-Rodriguez; Spiros Denaxas; Ruzan Udumyan; Mika Kivimaki; Harry Hemingway Journal: PLoS One Date: 2016-04-22 Impact factor: 3.240
Authors: J Danesh; S Erqou; M Walker; S G Thompson; R Tipping; C Ford; S Pressel; G Walldius; I Jungner; A R Folsom; L E Chambless; M Knuiman; P H Whincup; S G Wannamethee; R W Morris; J Willeit; S Kiechl; P Santer; A Mayr; N Wald; S Ebrahim; D A Lawlor; J W G Yarnell; J Gallacher; E Casiglia; V Tikhonoff; P J Nietert; S E Sutherland; D L Bachman; J E Keil; M Cushman; B M Psaty; R P Tracy; A Tybjaerg-Hansen; B G Nordestgaard; R Frikke-Schmidt; S Giampaoli; L Palmieri; S Panico; D Vanuzzo; L Pilotto; L Simons; J McCallum; Y Friedlander; F G R Fowkes; A J Lee; F B Smith; J Taylor; J Guralnik; C Phillips; R Wallace; D Blazer; K T Khaw; J H Jansson; C Donfrancesco; V Salomaa; K Harald; P Jousilahti; E Vartiainen; M Woodward; R B D'Agostino; P A Wolf; R S Vasan; M J Pencina; E M Bladbjerg; T Jorgensen; L Moller; J Jespersen; R Dankner; A Chetrit; F Lubin; A Rosengren; L Wilhelmsen; G Lappas; H Eriksson; C Bjorkelund; P Cremer; D Nagel; R Tilvis; T Strandberg; B Rodriguez; L M Bouter; R J Heine; J M Dekker; G Nijpels; C D A Stehouwer; E Rimm; J Pai; S Sato; H Iso; A Kitamura; H Noda; U Goldbourt; V Salomaa; J T Salonen; K Nyyssönen; T-P Tuomainen; D Deeg; J L Poppelaars; T Meade; J Cooper; B Hedblad; G Berglund; G Engstrom; A Döring; W Koenig; C Meisinger; W Mraz; L Kuller; R Selmer; A Tverdal; W Nystad; R Gillum; M Mussolino; S Hankinson; J Manson; B De Stavola; C Knottenbelt; J A Cooper; K A Bauer; R D Rosenberg; S Sato; Y Naito; I Holme; H Nakagawa; H Miura; P Ducimetiere; X Jouven; C Crespo; M Garcia-Palmieri; P Amouyel; D Arveiler; A Evans; J Ferrieres; H Schulte; G Assmann; J Shepherd; C Packard; N Sattar; B Cantin; B Lamarche; J-P Després; G R Dagenais; E Barrett-Connor; D Wingard; R Bettencourt; V Gudnason; T Aspelund; G Sigurdsson; B Thorsson; M Trevisan; J Witteman; I Kardys; M Breteler; A Hofman; H Tunstall-Pedoe; R Tavendale; G D O Lowe; Y Ben-Shlomo; B V Howard; Y Zhang; L Best; J Umans; A Onat; T W Meade; I Njolstad; E Mathiesen; M L Lochen; T Wilsgaard; J M Gaziano; M Stampfer; P Ridker; H Ulmer; G Diem; H Concin; F Rodeghiero; A Tosetto; E Brunner; M Shipley; J Buring; S M Cobbe; I Ford; M Robertson; Y He; A M Ibanez; E J M Feskens; D Kromhout; R Collins; E Di Angelantonio; S Kaptoge; S Lewington; L Orfei; L Pennells; P Perry; K Ray; N Sarwar; M Scherman; A Thompson; S Watson; F Wensley; I R White; A M Wood Journal: Eur J Epidemiol Date: 2007-09-18 Impact factor: 8.082
Authors: Debra D Dixon; Meng Xu; Elvis A Akwo; Devika Nair; David Schlundt; Thomas J Wang; William J Blot; Loren Lipworth; Deepak K Gupta Journal: JACC Heart Fail Date: 2022-02-09 Impact factor: 12.035
Authors: Adina Zeki Al Hazzouri; Neal Jawadekar; Katrina Kezios; Michelle R Caunca; Tali Elfassy; Sebastian Calonico; Kiarri N Kershaw; Kristine Yaffe; Lenore Launer; Martine Elbejjani; Leslie Grasset; Jennifer Manly; Michelle C Odden; M Maria Glymour Journal: Am J Epidemiol Date: 2022-03-24 Impact factor: 5.363
Authors: Sara R Kellahan; Xinliang Huang; Daphne Lew; Hong Xian; Seth Eisen; Alfred H J Kim Journal: Arthritis Care Res (Hoboken) Date: 2021-12-10 Impact factor: 5.178
Authors: Renate B Schnabel; Gert Hasenfuß; Sylvia Buchmann; Kai G Kahl; Stefanie Aeschbacher; Stefan Osswald; Christiane E Angermann Journal: Herz Date: 2021-02-05 Impact factor: 1.443
Authors: Mia D Eriksson; Johan G Eriksson; Hannu Kautiainen; Minna K Salonen; Tuija M Mikkola; Eero Kajantie; Niko Wasenius; Mikaela von Bonsdorff; Päivi Korhonen; Merja K Laine Journal: Ann Med Date: 2021-12 Impact factor: 5.348