title: Depression symptom severity and reported treatment history in the prediction of cardiac risk in women with suspected myocardial ischemia: The NHLBI-sponsored WISE study.
abstract: BACKGROUND
  Depression is associated with clinical events and premature mortality among patients with established coronary artery disease (CAD). Typically, however, studies in this area focus only on baseline symptom severity and lack any data concerning symptom duration or symptom history.
  
  
  OBJECTIVE
  To describe and compare the relationships between 2 measures of depression-assessed in the form of depression symptom severity and reported treatment history-with atherosclerosis risk factors and major clinical events in a sample of women with suspected myocardial ischemia.
  
  
  METHODS
  Follow-up study of women who completed a diagnostic CAD protocol, including cardiac symptoms, coronary angiography, ischemic testing, and assessments of depression symptom severity and reported treatment history.
  
  
  METHODS
  The Women's Ischemia Syndrome Evaluation (WISE), a National Heart, Lung, and Blood Institute (NHLBI)-sponsored multicenter study assessing cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia.
  
  
  METHODS
  Five hundred five women (mean age, 53.4 years) enrolled in WISE and followed up for a mean of 4.9 years.
  
  
  METHODS
  Incidence of cardiac events, including myocardial infarction, stroke, and heart failure, and total mortality.
  
  
  RESULTS
  Relative to those with no or less stable depression symptoms, women with elevated depression symptoms and a reported treatment history showed higher rates of smoking, hypertension, and poorer education and an increased incidence of death and cardiac events (multivariate-adjusted risk ratio, 3.1; 95% confidence interval, 1.5-6.3; P = .001).
  
  
  CONCLUSIONS
  Among women with suspected myocardial ischemia, a combination of depressive symptom severity and treatment history was a strong predictor of an elevated CAD risk profile and increased risk of cardiac events compared with those without depression or with only 1 of the 2 measured depression markers. These findings reinforce the importance of assessing mental health factors in women at elevated CAD risk. Focusing only on baseline depression symptom severity may provide an incomplete picture of CAD risk.
authors.affiliation: Department of Psychiatry, VA San Diego Healthcare System and University of California, San Diego, CA 92161, USA. Thomas.Rutledge@med.va.gov
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: Jane
authors.initials: J
authors.lastname: Owens
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Sunil
authors.initials: S
authors.lastname: Mankad
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Carol E
authors.initials: CE
authors.lastname: Cornell
authors.forename: Barry
authors.initials: B
authors.lastname: Sharaf
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
mesh_terms: D002423:Cause of Death; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology