Symptoms of depression as a prospective risk factor for stroke

Objective: The objective of this study was to assess baseline levels of dep ression as a risk factor for stroke among white and black men and women. Me thods: A population-based cohort of 6095 stroke-free white and black men an d women aged 25 to 74 years in the NHANES I Epidemiologic Followup Study we re followed for an average of 16 years to a maximum of 22 years. The associ ation between stroke and baseline self-reported depressive symptomatology w as analyzed using Cox proportional hazards models adjusting for baseline ag e, race, sex, education, smoking status, body mass index, alcohol use, nonr ecreational physical activity, serum cholesterol level, history of diabetes , history of heart disease, and systolic blood pressure. Hospital records a nd death certificates were used to identify stroke cases; a total of 483 ca ses were identified. Results: In age-adjusted models for all persons, white men, white women, and black persons of both sexes, depression was predicti ve of stroke. In risk-adjusted models for all persons (relative risk (RR) = 1.73, 95% confidence interval (CI) = 1.30-2.31) and for white men (RR = 1. 68, 95% CI = 1.02-2.75), depression remained predictive of stroke. For whit e women, depression (RR = 1.52, 95% CI = 0.97-2.38) reached borderline sign ificance (p = .07). For black persons, depression (RR = 2.60, 95% CI = 1.40 -4.80) demonstrated a higher risk of stroke. A series of supplemental analy ses also supported the association between depression and stroke. Conclusio ns: Depression is predictive of stroke across all strata. This nationally r epresentative study gives evidence of a prospective association between dep ression and stroke.