Depression is associated with cardiac symptoms, mortality risk, and hospitalization among women with suspected coronary disease: the NHLBI-sponsored WISE study.
OBJECTIVE
Depression is a robust predictor of cardiovascular risk. In this study, we examined the association between depression measured in terms of symptom severity and treatment history, cardiac symptom presentation, and clinical outcomes among a sample of women with suspected myocardial ischemia.


METHODS
Seven hundred fifty women with chest pain, mean age 53.4, completed a diagnostic protocol including depression measures, coronary angiogram, ischemia testing, and coronary disease risk factor assessment. Five hundred five participants also completed the Beck Depression Inventory. We further tracked participants over a mean 2.3-year period to evaluate subsequent cardiac events, hospitalization, and mortality.


RESULTS
Depression treatment history and current symptom severity were differentially associated with cardiac symptoms and outcomes. Both measures were reliably associated with coronary artery disease (CAD) risk factors and more severe cardiac symptoms. Depression symptom severity was linked to an increased mortality risk over follow-up (RR = 1.05; 95% CI, 1.01-1.09), whereas depression treatment history predicted an increased risk of hospitalization (RR = 1.3; 95% CI, 1.02-1.6), less severe CAD from angiogram, and a reduced likelihood of a positive ischemia test.


CONCLUSIONS
Among a sample of women with suspected myocardial ischemia, depression was associated with cardiac symptoms and health outcomes over follow-up. The findings extend the range of depression effects by demonstrating relationships within a sample of women experiencing symptoms of myocardial ischemia but showing a relative absence of flow limiting coronary stenoses. Depression measurements can assist the clinician in evaluating cardiac symptom presentation and cardiovascular risk status in women.
University of California, San Diego, CA, USA. Thomas.Rutledge@med.va.gov
Thomas
T
Rutledge
Steven E
SE
Reis
Marian
M
Olson
Jane
J
Owens
Sheryl F
SF
Kelsey
Carl J
CJ
Pepine
Sunil
S
Mankad
William J
WJ
Rogers
George
G
Sopko
Carol E
CE
Cornell
Barry
B
Sharaf
C Noel Bairey
CN
Merz
D000787:Angina Pectoris / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors