title: Are depressive symptoms associated with cardiovascular mortality among older Chinese: a cohort study of 64,000 people in Hong Kong?
abstract: BACKGROUND
  Depression was positively associated with cardiovascular disease (CVD) or mortality in previous studies. However, whether the observed association can be explained by health status is not clear.
  
  
  OBJECTIVE
  To study the association of depressive symptoms with CVD, stroke, and coronary heart disease (CHD) mortality in older Chinese in Hong Kong, and whether the associations varied by gender or health status.
  
  
  METHODS
  Prospective population-based study.
  
  
  METHODS
  Elderly Health Centers.
  
  
  METHODS
  A total of 62,839 people age 65 or older (21,473 men and 41,366 women) enrolled during July 1998 to December 2001 at all 18 Elderly Health Centers of the Department of Health of Hong Kong.
  
  
  METHODS
  Fifteen-item Geriatric Depression Scale (GDS) was used and presence of depressive symptoms was defined by GDS score 8 or more. The cohort was followed up for mortality till March 31, 2009.
  
  
  RESULTS
  Depressive symptoms were only associated with CHD mortality in men (hazard ratio [HR] 1.41, 95% confidence interval [CI]: 1.08-1.84; p for gender interaction = 0.02) adjusted for age, education, monthly expenditure, smoking, alcohol use, physical activity, body mass index, health status, and self-rated health. GDS score was associated with stroke mortality (similarly adjusted HR 1.02 per score, 95% CI: 1.00-1.04) in all subjects (adjusted also for gender), and CHD mortality (1.04 [1.01-1.07]) in men. Health status attenuated but did not modify any associations.
  
  
  CONCLUSIONS
  Depressive symptoms were independently associated with higher CHD mortality in older Chinese men, and with higher stroke mortality in both genders. However, attenuation by health status, and lack of consistency by gender indicate that these associations could be noncausal and further studies by treatment trials and Mendelian randomization are needed.
authors.affiliation: Department of Community Medicine and School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
authors.forename: Wen Jie
authors.initials: WJ
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Wai Man
authors.initials: WM
authors.lastname: Chan
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000523:psychology; D003863:Depression / Q000150:complications; D005260:Female; D006304:Health Status; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000523:psychology
keywords: Cardiovascular mortality; Geriatric Depression Scale; coronary heart disease mortality; depressive symptoms; stroke mortality