Depressive symptoms and risk of stroke: the Framingham Study.
OBJECTIVE
Emerging evidence raises the possibility of an association between depression and stroke risk. This study sought to examine whether depressive symptoms are associated with an increased risk of cerebrovascular events in a community-based sample.


METHODS
A prospective study was conducted on 4120 Framingham Heart Study participants aged 29 to 100 years with up to 8 years of follow-up. The Center for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Incident stroke and transient ischemic attack (TIA) events were assessed by uniform diagnostic criteria. The association between depressive symptoms and risk of stroke/TIA was analyzed with Cox proportional-hazards models, after adjusting for traditional stroke risk factors.


RESULTS
In participants <65 years, the risk of developing stroke/TIA was 4.21 times greater (P= <0.001) in those with symptoms of depression. After adjusting for components of the Framingham Stroke Risk Profile (hazard ratio=3.43, 95% CI=1.60 to 7.36, P=0.002) and education (hazard ratio=4.89, 95% CI=2.19 to 10.95), similar results were obtained. In subjects aged 65 and older, depressive symptoms were not associated with an increased risk of stroke/TIA. Taking antidepressant medications did not alter the risk associated with depressive symptoms.


CONCLUSIONS
In this community-based study, depressive symptoms were an independent risk factor for incident stroke/TIA in individuals <65 years. These data suggest that identification of depressive symptoms at younger ages may have an impact on the primary prevention of stroke.
Salaycik
Kimberly J
KJ
Department of Neurology, Framingham Heart Study, Boston University School of Medicine, 715 Albany St, B-608B, Boston, MA 02118-2526, USA.
Kelly-Hayes
Margaret
M
Beiser
Alexa
A
Nguyen
Anh-Hoa
AH
Brady
Stephen M
SM
Kase
Carlos S
CS
Wolf
Philip A
PA
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000928:Antidepressive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D042241:Early Diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000639:trends; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*
D000928:Antidepressive Agents