Depression, dietary habits, and cardiovascular events among women with suspected myocardial ischemia.
BACKGROUND
Dietary habits and depression are associated with cardiovascular disease risk. Patients with depression often report poor eating habits, and dietary factors may help explain commonly observed associations between depression and cardiovascular disease.


METHODS
From 1996 to 2000, 936 women were enrolled in the Women's Ischemia Syndrome Evaluation at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (median follow-up, 5.9 years) for adverse outcomes (cardiovascular disease death, heart failure, myocardial infarction, stroke). Participants completed a protocol including coronary angiography (coronary artery disease severity) and depression assessments (Beck Depression Inventory scores, antidepressant use, and depression treatment history). A subset of 201 women (mean age, 58.5 years; standard deviation, 11.4) further completed the Food Frequency Questionnaire for Adults (1998 Block). We extracted daily fiber intake and daily servings of fruit and vegetables as measures of dietary habits.


RESULTS
In separate Cox regression models adjusted for age, smoking, and coronary artery disease severity, Beck Depression Inventory scores (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.10), antidepressant use (HR, 2.4; 95% CI, 1.01-5.9), and a history of treatment for depression (HR, 2.4; 95% CI, 1.1-5.3) were adversely associated with time to cardiovascular disease outcomes. Fiber intake (HR, 0.87; 95% CI, 0.78-0.97) and fruit and vegetable consumption (HR, 0.36; 95% CI, 0.19-0.70) were associated with a decreased time to cardiovascular disease event risk. In models including dietary habits and depression, fiber intake and fruit and vegetable consumption remained associated with time to cardiovascular disease outcomes, whereas depression relationships were reduced by 10% to 20% and nonsignificant.


CONCLUSIONS
Among women with suspected myocardial ischemia, we observed consistent relationships among depression, dietary habits, and time to cardiovascular disease events. Dietary habits partly explained these relationships. These results suggest that dietary habits should be included in future efforts to identify mechanisms linking depression to cardiovascular disease.
VA San Diego Healthcare System, San Diego, Calif; University of California, San Diego. Electronic address: Thomas.Rutledge@va.gov.
Thomas
T
Rutledge
University of Pittsburgh, Pittsburgh, Pa.
Tanya S
TS
Kenkre
Allegheny General Hospital, Pittsburgh, Pa.
Diane V
DV
Thompson
University of Alabama at Birmingham, Birmingham.
Vera A
VA
Bittner
Uniformed Services University of the Health Sciences, Bethesda, Md.
Kerry
K
Whittaker
UCLA School of Nursing, Los Angeles, Calif.
Jo-Ann
JA
Eastwood
University of Pittsburgh, Pittsburgh, Pa.
Wafia
W
Eteiba
University of Arkansas for Medical Sciences, Little Rock.
Carol E
CE
Cornell
Uniformed Services University of the Health Sciences, Bethesda, Md.
David S
DS
Krantz
University of Florida, Gainesville.
Carl J
CJ
Pepine
University of Pittsburgh, Pittsburgh, Pa.
B Delia
BD
Johnson
University of Florida, Gainesville.
Eileen M
EM
Handberg
Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, Calif.
C Noel
CN
Bairey Merz
D000328:Adult; D000368:Aged; D003863:Depression / Q000150:complications*; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000523:psychology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000523:psychology
Cardiovascular disease; Depression; Diet; Prospective; Women