title: Differential associations between specific depressive symptoms and cardiovascular prognosis in patients with stable coronary heart disease.
abstract: OBJECTIVE
  The purpose of this research was to evaluate the relationship between cognitive and somatic depressive symptoms and cardiovascular prognosis.
  
  
  BACKGROUND
  Depression in patients with stable coronary heart disease (CHD) is associated with poor cardiac prognosis. Whether certain depressive symptoms are more cardiotoxic than others is unknown.
  
  
  METHODS
  In the Heart and Soul Study, 1,019 patients with stable CHD were assessed using the Patient Health Questionnaire to determine the presence of the 9 depressive symptoms included in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. The mean age of the patients was 67 years, and 82% were men. A comparison was made on a new cardiovascular event (myocardial infarction, stroke, transient ischemic attack, or congestive heart failure) or death (mean follow-up duration 6.1 +/- 2.0 years) on the basis of cognitive and somatic sum scores and for patients with or without each of those specific depressive symptoms. Demographic characteristics, cardiac risk factors, and cardiac medications were controlled for.
  
  
  RESULTS
  After adjustment for demographic data and cardiac risk factors, each somatic symptom was associated with 14% greater risk for events (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.05 to 1.24; p = 0.002). Fatigue (HR: 1.34; 95% CI: 1.07 to 1.67; p = 0.01), appetite problems (HR: 1.46; 95% CI: 1.12 to 1.91; p = 0.005), and sleeping difficulties (HR: 1.26; 95% CI: 1.00 to 1.58; p = 0.05) were most strongly predictive of cardiovascular events. In contrast, cognitive symptoms (HR: 1.08; 95% CI: 0.99 to 1.17; p = 0.09) were not significantly associated with cardiovascular events.
  
  
  CONCLUSIONS
  In patients with stable CHD, somatic symptoms of depression were more strongly predictive of cardiovascular events than cognitive symptoms, although the CIs surrounding these estimates had substantial overlap. These findings are highly consistent with those of previous studies. Further research is needed to understand the pathophysiological processes by which somatic depressive symptoms contribute to prognosis in patients with CHD.
authors.affiliation: Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands. p.w.hoen@med.umcg.nl
authors.forename: Petra W
authors.initials: PW
authors.lastname: Hoen
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Martens
authors.forename: Beeya
authors.initials: B
authors.lastname: Na
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000150:complications* / Q000523:psychology*; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors
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