Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events

Amit J. Shah, Nima Ghasemzadeh, Elisa Zaragoza-Macias, Riyaz Patel, Danny J. Eapen, Ian J. Neeland, Pratik M. Pimple, A. Maziar Zafari, Arshed A. Quyyumi, Viola Vaccarino

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background-Young women with coronary heart disease have high rates of depression and a higher risk of adverse events than men of similar age. Whether depression has a higher prognostic value in this group than in men and older women is not known. Our objective was to assess whether depression in young women is associated with higher risk of coronary artery disease (CAD) and adverse outcomes compared with similarly aged men and older women. Methods and Results-We examined 3237 patients undergoing coronary angiography for evaluation of CAD and followed them for 2.9 years (median). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9, and CAD burden was dichotomized based on its presence or absence. After multivariable adjustment for CAD risk factors, depressive symptoms predicted CAD presence in women aged ≤55 years (odds ratio=1.07 95% confidence interval [CI] 1.02 to 1.13 per 1 point increase in PHQ-9 score), but not in men aged ≤55 years or women aged >55 years. Depressive symptoms also predicted increased risk of death in women aged ≤55 years (adjusted hazard ratio=1.07, 95% CI 1.02 to 1.14, per 1 point increase in PHQ-9 score), but not in men aged ≤55 years and women aged >55 years, with P=0.02 for the depression-sex interaction and P=0.02 for depression-sexage interaction. Conclusions-Among patients with suspected or established CAD, depressive symptoms are associated with increased risk of death, particularly in young women. This group may be especially vulnerable to the adverse cardiovascular effects of depression.

Original languageEnglish (US)
Article number000741
JournalJournal of the American Heart Association
Volume3
Issue number3
DOIs
StatePublished - Jan 1 2014

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Sex Characteristics
Coronary Artery Disease
Depression
Health
Confidence Intervals
Coronary Angiography
Coronary Disease
Odds Ratio

Keywords

  • Coronary artery disease
  • Depression
  • Sex differences

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events. / Shah, Amit J.; Ghasemzadeh, Nima; Zaragoza-Macias, Elisa; Patel, Riyaz; Eapen, Danny J.; Neeland, Ian J.; Pimple, Pratik M.; Zafari, A. Maziar; Quyyumi, Arshed A.; Vaccarino, Viola.

In: Journal of the American Heart Association, Vol. 3, No. 3, 000741, 01.01.2014.

Research output: Contribution to journalArticle

Shah, AJ, Ghasemzadeh, N, Zaragoza-Macias, E, Patel, R, Eapen, DJ, Neeland, IJ, Pimple, PM, Zafari, AM, Quyyumi, AA & Vaccarino, V 2014, 'Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events', Journal of the American Heart Association, vol. 3, no. 3, 000741. https://doi.org/10.1161/JAHA.113.000741
Shah, Amit J. ; Ghasemzadeh, Nima ; Zaragoza-Macias, Elisa ; Patel, Riyaz ; Eapen, Danny J. ; Neeland, Ian J. ; Pimple, Pratik M. ; Zafari, A. Maziar ; Quyyumi, Arshed A. ; Vaccarino, Viola. / Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 3.
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abstract = "Background-Young women with coronary heart disease have high rates of depression and a higher risk of adverse events than men of similar age. Whether depression has a higher prognostic value in this group than in men and older women is not known. Our objective was to assess whether depression in young women is associated with higher risk of coronary artery disease (CAD) and adverse outcomes compared with similarly aged men and older women. Methods and Results-We examined 3237 patients undergoing coronary angiography for evaluation of CAD and followed them for 2.9 years (median). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9, and CAD burden was dichotomized based on its presence or absence. After multivariable adjustment for CAD risk factors, depressive symptoms predicted CAD presence in women aged ≤55 years (odds ratio=1.07 95{\%} confidence interval [CI] 1.02 to 1.13 per 1 point increase in PHQ-9 score), but not in men aged ≤55 years or women aged >55 years. Depressive symptoms also predicted increased risk of death in women aged ≤55 years (adjusted hazard ratio=1.07, 95{\%} CI 1.02 to 1.14, per 1 point increase in PHQ-9 score), but not in men aged ≤55 years and women aged >55 years, with P=0.02 for the depression-sex interaction and P=0.02 for depression-sexage interaction. Conclusions-Among patients with suspected or established CAD, depressive symptoms are associated with increased risk of death, particularly in young women. This group may be especially vulnerable to the adverse cardiovascular effects of depression.",
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AU - Shah, Amit J.

AU - Ghasemzadeh, Nima

AU - Zaragoza-Macias, Elisa

AU - Patel, Riyaz

AU - Eapen, Danny J.

AU - Neeland, Ian J.

AU - Pimple, Pratik M.

AU - Zafari, A. Maziar

AU - Quyyumi, Arshed A.

AU - Vaccarino, Viola

PY - 2014/1/1

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N2 - Background-Young women with coronary heart disease have high rates of depression and a higher risk of adverse events than men of similar age. Whether depression has a higher prognostic value in this group than in men and older women is not known. Our objective was to assess whether depression in young women is associated with higher risk of coronary artery disease (CAD) and adverse outcomes compared with similarly aged men and older women. Methods and Results-We examined 3237 patients undergoing coronary angiography for evaluation of CAD and followed them for 2.9 years (median). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9, and CAD burden was dichotomized based on its presence or absence. After multivariable adjustment for CAD risk factors, depressive symptoms predicted CAD presence in women aged ≤55 years (odds ratio=1.07 95% confidence interval [CI] 1.02 to 1.13 per 1 point increase in PHQ-9 score), but not in men aged ≤55 years or women aged >55 years. Depressive symptoms also predicted increased risk of death in women aged ≤55 years (adjusted hazard ratio=1.07, 95% CI 1.02 to 1.14, per 1 point increase in PHQ-9 score), but not in men aged ≤55 years and women aged >55 years, with P=0.02 for the depression-sex interaction and P=0.02 for depression-sexage interaction. Conclusions-Among patients with suspected or established CAD, depressive symptoms are associated with increased risk of death, particularly in young women. This group may be especially vulnerable to the adverse cardiovascular effects of depression.

AB - Background-Young women with coronary heart disease have high rates of depression and a higher risk of adverse events than men of similar age. Whether depression has a higher prognostic value in this group than in men and older women is not known. Our objective was to assess whether depression in young women is associated with higher risk of coronary artery disease (CAD) and adverse outcomes compared with similarly aged men and older women. Methods and Results-We examined 3237 patients undergoing coronary angiography for evaluation of CAD and followed them for 2.9 years (median). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9, and CAD burden was dichotomized based on its presence or absence. After multivariable adjustment for CAD risk factors, depressive symptoms predicted CAD presence in women aged ≤55 years (odds ratio=1.07 95% confidence interval [CI] 1.02 to 1.13 per 1 point increase in PHQ-9 score), but not in men aged ≤55 years or women aged >55 years. Depressive symptoms also predicted increased risk of death in women aged ≤55 years (adjusted hazard ratio=1.07, 95% CI 1.02 to 1.14, per 1 point increase in PHQ-9 score), but not in men aged ≤55 years and women aged >55 years, with P=0.02 for the depression-sex interaction and P=0.02 for depression-sexage interaction. Conclusions-Among patients with suspected or established CAD, depressive symptoms are associated with increased risk of death, particularly in young women. This group may be especially vulnerable to the adverse cardiovascular effects of depression.

KW - Coronary artery disease

KW - Depression

KW - Sex differences

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