title: Depressive Symptoms and Risk of Cardiovascular Events in Blacks: Findings From the Jackson Heart Study.
abstract: BACKGROUND
  Most studies of depression and cardiovascular risk have been conducted in white populations. We investigated this association in a community-based cohort of blacks.
  
  
  RESULTS
  We used data from the Jackson Heart Study to investigate associations of baseline depressive symptoms between 2000 and 2004 with incident stroke and coronary heart disease (CHD) during 10 years. We used Kaplan-Meier estimates and Cox proportional hazards models to assess cardiovascular event risk using 3 exposure variables: any depressive symptoms (Center for Epidemiological Studies Depression score ≥16); none (score <16), minor (score 16 to <21), and major depression (score≥21); and Center for Epidemiological Studies Depression score per 1-SD increase. Models were adjusted for a stroke or CHD risk score and behavioral risk factors. Of 3309 participants with no stroke history, 738 (22.3%) had baseline depressive symptoms. A similar proportion with no previous CHD had baseline depressive symptoms (21.8%). The unadjusted 10-year risk of stroke was similar among participants with any compared with no depressive symptoms (3.7% versus 2.6%; P=0.12). Unadjusted CHD rates were higher among participants with depressive symptoms (5.6% versus 3.6%; P=0.03), and differences persisted after adjustment for clinical and behavioral risk factors but not after adjustment for coping strategies. In adjusted models comparing major versus no depressive symptoms, patients with major depressive symptoms had a 2-fold greater hazard of stroke (hazard ratio, 1.95; 95% confidence interval, 1.02-3.71; P=0.04). In continuous models, a 1-SD increase in Center for Epidemiological Studies Depression score was associated with a 30% increase in adjusted incident stroke risk (P=0.04). Similar associations were observed for incident CHD in models adjusted for clinical and behavioral risk factors, but associations were not significant after adjustment for coping strategies.
  
  
  CONCLUSIONS
  In a community-based cohort of blacks, major depressive symptoms were associated with greater risks of incident stroke and CHD after adjustment for clinical and behavioral risk factors.
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.). emily.obrien@duke.edu.
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Natalie Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Department of Medicine, Duke Clinical Research Institute (E.C.O., M.A.G., N.C.H., A.F.H., L.H.C.) Duke University School of Medicine, Durham, NC; Department of Medicine, University of Mississippi Medical Center, Jackson (W.W.) and Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (E.S.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology* / Q000523:psychology; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: cardiovascular diseases; depression; proportional hazards models; risk factors; stroke