Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: A report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation.
BACKGROUND
Symptoms of depression and cardiovascular disease (CVD) overlap substantially. Differentiating between dimensions of depressive symptoms may improve our understanding of the relationship between depression and physical health.


OBJECTIVE
To compare symptom dimensions of depression as predictors of cardiovascular-related death and events among women with suspected myocardial ischemia.


METHODS
Cohort study of women with suspected myocardial ischemia who underwent evaluation at baseline for a history of cardiovascular-related problems, depressive symptoms using the Beck Depression Inventory, and coronary artery disease severity via coronary angiography. Principal components analyses (PCAs) of the Beck Depression Inventory items were conducted to examine differential cardiovascular prognosis according to symptom dimensions of depression.


METHODS
The Women's Ischemia Syndrome Evaluation (WISE), a multicenter study sponsored by the National Heart, Lung, and Blood Institute to assess 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 fifty women (mean [SD] age, 58.4 [11.2] years) enrolled in the WISE study and followed up for a median of 5.8 years.


METHODS
Cardiovascular-related mortality and events (stroke, myocardial infarction, and congestive heart failure).


RESULTS
When a 3-factor structure from PCA was used, somatic/affective (hazards ratio, 1.35; 95% confidence interval, 1.04-1.74) and appetitive (1.42; 1.21-1.68) but not cognitive/affective (0.89; 0.70-1.14) symptoms predicted cardiovascular prognosis in adjusted multivariate Cox regression analysis. When a 2-factor structure from PCA was used, adjusted results indicated that somatic (hazards ratio, 1.63; 95% confidence interval, 1.28-2.08) but not cognitive/affective (0.87; 0.68-1.11) symptoms predicted worse prognosis.


CONCLUSIONS
In a sample of women with suspected myocardial ischemia, somatic but not cognitive/affective depressive symptoms were associated with an increased risk of cardiovascular-related mortality and events. These results support the need to research dimensions of depression in CVD populations and have implications for understanding the connection between depression and CVD.
Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, USA. slinke@ucsd.edu
Sarah E
SE
Linke
Thomas
T
Rutledge
B Delia
BD
Johnson
Viola
V
Vaccarino
Vera
V
Bittner
Carol E
CE
Cornell
Wafia
W
Eteiba
David S
DS
Sheps
David S
DS
Krantz
Susmita
S
Parashar
C Noel
CN
Bairey Merz
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000523:psychology*; D054555:National Heart, Lung, and Blood Institute (U.S.); D010555:Personality Inventory / Q000706:statistics & numerical data; D025341:Principal Component Analysis; D011379:Prognosis; D011594:Psychometrics / Q000706:statistics & numerical data; D012307:Risk Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D015996:Survival Rate; D013577:Syndrome; D014481:United States; D016387:Women's Health