title: Relation of Persistent Depressive Symptoms to Coronary Artery Calcification in Women Aged 46 to 59 Years.
abstract: Depressive disorders have been associated with cardiovascular disease (CVD), but the impact of depression on early atherogenesis has not been well described, particularly in women and minorities. The relation between repeated episodes of high depressive symptoms and coronary calcium (CAC) is unknown in women at midlife when depression is common. Participants in the Study of Women's Health Across the Nation Heart study were assessed annually for depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D scale]) over 5 years before CAC assessment and classified as high (CES-D ≥16) or not. CAC, measured by computed tomography, was analyzed as a categorical variable using cumulative logit partial proportional odds models. In these middle-aged women free of CVD and diabetes (194 black, 334 white), high depressive symptoms over 5 years were common; 19% had 1, 9% had 2, and 11% experienced ≥3 episodes. CAC was low; 54% had no CAC, 25% had scores from 0 to 10, and 21% had CAC ≥10 Agatston score. After adjusting for CVD risk factors, women with ≥3 episodes were twice as likely to have significant CAC (≥10 Agatston units) than women with no depressive episodes (odds ratio 2.20, 95% confidence interval 1.13 to 4.28, p = 0.020) with no difference by race. Women with 1 or 2 episodes did not differ from women with no episodes. In conclusion, in healthy women aged 46 to 59 years without clinical CVD or diabetes, persistent depressive symptoms were significantly associated with elevated CAC scores, suggesting that they are more likely to have pathophysiological and behavioral effects on the development of subclinical CVD than does a single episode of elevated depressive symptoms.
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois. Electronic address: Imke_Janssen@rush.edu.
authors.forename: Imke
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Departments of Preventive Medicine, Medicine (Cardiology), Behavioral Sciences, and Pharmacology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
authors.affiliation: Departments of Psychiatry, Epidemiology and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Mateusz S
authors.initials: MS
authors.lastname: Jasielec
authors.affiliation: Division of Cardiology, Cooper University Hospital, Camden, New Jersey.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Hollenberg
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
mesh_terms: D000367:Age Factors; D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D016387:Women's Health