Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women - The Stockholm Female Coronary Risk Study

Aims Several studies have reported that women with coronary heart disease h ave a poorer prognosis than men. Psychosocial factors, including social iso lation and depressive symptoms have been suggested as a possible cause. How ever. little is known; about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depres sion, lack of social integration and their interaction in the Stockholm Fem ale Coronary Risk Study. Methods and Results Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed betwe en 3 and 6 months after admission. Lack of social integration and depressiv e symptoms, assessed at baseline by standardized questionnaires, were assoc iated with recurrent events. including cardiovascular mortality, acute myoc ardial infarction and revascularization procedures (percutaneous translumin al coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event. symptoms of heart failure, diabetes mellitu s, high density lipoprotein (HDL) cholesterol, history of hypertension, sys tolic blood pressure, smoking, sedentary lifestyle, body mass index, and se verity of angina pectoris symptoms. the hazard ratio associated with low (l owest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upp er three quartiles) as compared to one or no depressive symptoms was 1.9 (9 5% CI 1.02-3 6). Conclusions The presence of two or more depressive symptoms and lack of soc ial integration independently predicted recurrent cardiac events in women w ith coronary heart disease. Women who were free of both these risk factors, had the best prognosis. (C) 2000 The European Society of Cardiology.