Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans

Background-Several epidemiological studies have associated depressive sympt oms with cardiovascular disease. We investigated whether depressive symptom s constituted a risk for coronary heart disease (CHD) and total mortality a mong an apparently healthy elderly cohort. Methods and Results-In a prospective cohort of 5888 elderly Americans (grea ter than or equal to 65 years) who were enrolled in the Cardiovascular Heal th Study, 4493 participants who were free of cardiovascular disease at base line provided annual information on their depressive status, which was asse ssed using the Depression Scale of the Center for Epidemiological Studies. These 4493 subjects were followed for 6 years for the development of CHD an d mortality. The cumulative mean depression score was assessed for each par ticipant up to the time of event (maximum 6-year follow-up). Using time-dep endent, proportional-hazards models, the unadjusted hazard ratio associated with every 5-unit increase in mean depression score for the development of CHD was 1.15 (P=0.006); the ratio for all-cause mortality was 1.29 (P<0.00 01), In multivariate analyses adjusted for age, race, sex, education, diabe tes, hypertension, cigarette smoking, total cholesterol, triglyceride level , congestive heart failure, and physical inactivity, the hazard ratio for C HD was 1.15 (P=0.006) and that for all-cause mortality was 1.16 (P=0.006). Among participants with the highest cumulative mean depression scores, the risk of CHD increased by 40% and risk of death by 60% compared with those w ho had the lowest mean scores. Conclusions-Among elderly Americans, depressive symptoms constitute an inde pendent risk factor for the development of CHD and total mortality.