Depression and risk of heart failure among older persons with isolated systolic hypertension

Background: Investigators have shown that depression is associated with an increased risk of coronary heart disease in general and myocardial infarcti on in particular. However, it is unknown whether depression, independent of its association with myocardial infarction, is a risk factor for heart fai lure. Methods: This study examined whether depression was a predictor of incident heart failure among 4538 persons aged 60 years and older with isolated sys tolic hypertension who were enrolled in the Systolic Hypertension in the El derly Program (SHEP). Depression was defined as a score of 16 or more at ba seline on the Center for Epidemiological Studies Depression Scale (CES-D). The relationship between depression and heart failure was assessed using Co x proportional hazards regression. Results: The average follow-up was 4.5 years. Heart failure developed in 13 8 (3.2%) of 4317 nondepressed persons and in 18 (8.1%) of 221 depressed per sons. After controlling for age; sex; race; history of myocardial infarctio n, diabetes, or angina; blood pressure; cholesterol levels; electrocardiogr aphic abnormalities; smoking; disability; and SHEP treatment group, depress ed persons had more than a 2-fold higher risk of developing heart failure c ompared with nondepressed persons (hazard ratio, 2.59; 95% confidence inter val, 1.57-4.27; P < .001). After additional adjustment for the occurrence o f myocardial infarction during follow-up, depressed persons remained at ele vated risk of heart failure (hazard ratio, 2.82; 95% confidence interval, 1 .71-4.67; P < .001). Conclusions: Depression is independently associated with a substantial incr ease in the risk of heart failure among older persons with isolated systoli c hypertension. This association does not appear to be mediated by myocardi al infarction.