Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study

Abstract

Purpose To examine the association of depressive symptoms with coronary heart disease (CHD) endpoints by race and income. Methods Study participants were Blacks and Whites (n=24,443) without CHD at baseline from the national REasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Outcomes included acute CHD and CHD or revascularization. We estimated race-stratified multivariable Cox proportional hazards models of incident CHD and incident CHD or revascularization with the 4-item Center for Epidemiological Studies-Depression scale, adjusting for risk factors. Results Mean follow-up was 4.2+1.5 years, CHD incidence was 8.3 events per 1000 person years (n=366) among Blacks and 8.8 events per 1000 person years (n=613) among Whites. After adjustment for age, sex, marital status, region, and socioeconomic status, depressive symptoms were significantly associated with incident CHD among Blacks [HR 1.39 (95%CI 1.00-1.91)], but not among Whites [HR 1.10 (95%CI 0.74-1.64)]. In the fully-adjusted model, compared to Blacks who reported no depressive symptoms, those reporting depressive symptoms had greater risk for the composite endpoint of CHD or revascularization [HR 1.36 (95%CI 1.01-1.81)]. Depressive symptoms were not associated with incident CHD endpoints among Whites. Conclusions High depressive symptoms were associated with higher risk of CHD or revascularization for Blacks but not Whites.

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

“…Our findings add to a growing body of work indicating that psychosocial factors related to CVD risk are most deleterious for those with low income 21, 24, 25. Furthermore, our results suggest that it is the combination of psychosocial risk factors that is associated with the greatest vulnerability to poor cardiovascular health in low‐income persons.…”

“…Only recently have researchers begun to appreciate the information to be learned by considering both sets of factors simultaneously to better identify persons at elevated risk of poor cardiovascular outcomes and mortality 21, 23, 24, 25, 41. Whereas most prior work in this area has focused on the joint contributions of SES and a single psychosocial risk factor (eg, depression, stress), our research emphasized the importance of considering a confluence of psychosocial risk factors, in addition to SES, to identify those who are most vulnerable to CVD.…”

“…Given prior findings in the REGARDS study suggesting that individual psychosocial factors are particularly associated with CVD risk in those with low versus high income,24, 25 we examined annual household income as our primary SES indicator. Education was examined in a supplemental analysis.…”

Depressive Symptoms and Risk of Cardiovascular Events in Blacks

“…Prospective studies 1–5 and meta-analyses 6–8 have found positive associations between depressive symptoms and incident cardiovascular disease after adjustment for other psychosocial and physiological risk factors. Yet, most studies of depression and cardiovascular outcomes have been conducted in white populations.…”

Trauma and Posttraumatic Stress Disorder

“…However, epidemiological data indicate that PTSD is more prevalent among lower-socioeconomic status individuals 20 and African Americans compared with whites, Hispanics and Asians, 21 even when exposure to trauma is comparable. Prior studies have found that African Americans may be more vulnerable to the effects of psychological distress on incident CVD, 22,23 and there are known racial/ethnic and socioeconomic status disparities in CVD risk for women. Thus, it is possible that the effects of trauma and PTSD on incident CVD will be particularly pronounced for African American women and women of low socioeconomic status.…”