Depressive Symptoms and Risk of Cardiovascular Events in Blacks

Abstract

Background Most studies of depression and cardiovascular risk have been conducted in white populations. We investigated this association in a community-based cohort of African Americans. Methods and Results We used data from the Jackson Heart Study to investigate associations of baseline depressive symptoms between 2000 and 2004 with incident stroke and coronary heart disease over 10 years. We used Kaplan-Meier estimates and Cox proportional hazards models to assess cardiovascular event risk using 3 exposure variables: any depressive symptoms (CES-D score ≥ 16); none (score < 16), minor (score 16 to less than 21) and major depression (score ≥ 21); and Center for Epidemiologic Studies Depression (CES-D) score per 1 SD increase. Models were adjusted for a stroke or CHD risk score and behavioral risk factors. Of 3309 participants with no stroke history, 738 (22.3%) had baseline depressive symptoms. A similar proportion with no prior coronary heart disease had baseline depressive symptoms (21.8%). The unadjusted 10-year risk of stroke was similar among participants with any compared with no depressive symptoms (3.7% vs 2.6%; P = .12). Unadjusted CHD rates were higher among participants with depressive symptoms (5.6 % vs. 3.6 %; p=.03), and differences persisted after adjustment for clinical and behavioral risk factors but not after adjustment for coping strategies. In adjusted models comparing major vs no depressive symptoms, patients with major depressive symptoms had a twofold greater hazard of stroke (HR, 1.95; 95% CI, 1.02–3.71; P = .04). In continuous models, a 1 SD increase in CES-D score was associated with a 30% increase in adjusted incident stroke risk (P = .04). Similar associations were observed for incident CHD in models adjusted for clinical and behavioral risk factors, but associations were not significant after adjustment for coping strategies. Conclusions In a community-based cohort of African Americans, major depressive symptoms were associated with greater risks of incident stroke and coronary heart disease after adjustment for clinical and behavioral risk factors.

Cardiovascular Disease Burden and Socioeconomic Correlates: Findings From the Jackson Heart Study

“…Indeed, perceived discrimination has been positively associated with hypertension and health behaviors in the JHS. Furthermore, depressive symptoms have also been positively associated with incident stroke and coronary heart disease among black participants in the JHS. Depressive symptoms were found to be positively associated with incident coronary heart disease or revascularization among black but not white participants in the REGARDS (Reasons for Geographical and Racial Differences in Stroke) study .…”

Depressive symptoms are associated with worsened severity of the metabolic syndrome in African American women independent of lifestyle factors: A consideration of mechanistic links from the Jackson heart study

“…Depressive symptoms remains a significant public health concern in part because of its risks related to CVD, (Joynt et al, 2003; O’Brien et al, 2015) and T2DM (Mezuk et al, 2008) and in part because it may be under-recognized, particularly among African Americans (Gallo et al, 2005). In this cohort of African American participants of the Jackson Heart Study, we found that women (but not men) with an increasing degree of depressive symptoms at baseline had higher MetS severity over the course of follow-up.…”

Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study

“…A substantial body of evidence has documented the influence of psychosocial factors, such as negative emotional states, acute and chronic stressors, and social support, on CVD risk . However, few studies have examined psychosocial factors and CVD risk among blacks, with none of these studies specifically examining the associations of these variables with achievement of ideal CVH, as represented by the AHA LS7 . Thorough investigation of psychosocial stress in several dimensions and domains is warranted to better determine its effect on CVH outcomes in blacks, given their exposure to greater stressors from life circumstances and discrimination …”