Author + information
- Received July 22, 2009
- Revision received March 12, 2010
- Accepted March 23, 2010
- Published online September 7, 2010.
- Petra W. Hoen, BSc⁎,⁎ (, )
- Mary A. Whooley, MD§∥,
- Elisabeth J. Martens, PhD‡,
- Beeya Na, MPH§,
- Joost P. van Melle, MD† and
- Peter de Jonge, PhD⁎,‡
- ↵⁎Reprint requests and correspondence:
Ms. Petra W. Hoen, Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
Objectives 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.
The Heart and Soul Study was supported by the U.S. Department of Veterans Affairs Epidemiology Merit Review Program; the U.S. Department of Veterans Affairs Health Services Research and Development Service; grant R01 HL079235from the National Heart, Lung, and Blood Institute; the Paul Beeson Scholars Program of the American Federation for Aging Research; the Generalist Physician Faculty Scholars Program of the Robert Wood Johnson Foundation; the Ischemia Research and Education Foundation; and the Nancy Kirwan Heart Research Fund. The funding organizations had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. Dr. de Jonge was supported by VIDI grant 016.086.397from the Dutch Medical Research Council. All other authors have reported that they have no relationships to disclose.
- Received July 22, 2009.
- Revision received March 12, 2010.
- Accepted March 23, 2010.
- American College of Cardiology Foundation