Author + information
- Received September 4, 2012
- Accepted September 21, 2012
- Published online February 12, 2013.
- Siqin Ye, MD⁎,⁎ (, )
- Paul Muntner, PhD†,
- Daichi Shimbo, MD⁎,
- Suzanne E. Judd, PhD†,
- Joshua Richman, MD, PhD†,
- Karina W. Davidson, PhD⁎ and
- Monika M. Safford, MD‡
- ↵⁎Reprint requests and correspondence:
Dr. Siqin Ye, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH 9-309, New York, New York 10032
Objectives The aim of this study was to determine whether behavioral mechanisms explain the association between depressive symptoms and myocardial infarction (MI) or death in individuals with coronary heart disease (CHD).
Background Depressive symptoms are associated with increased morbidity and mortality in individuals with CHD, but it is unclear how much behavioral mechanisms contribute to this association.
Methods The study included 4,676 participants with a history of CHD. Elevated depressive symptoms were defined as scores ≥4 on the Center for Epidemiologic Studies Depression 4-item Scale. The primary outcome was definite/probable MI or death from any cause. Incremental proportional hazards models were constructed by adding demographic data, comorbidities, and medications and then 4 behavioral mechanisms (alcohol use, smoking, physical inactivity, and medication non-adherence).
Results At baseline, 638 (13.6%) participants had elevated depressive symptoms. Over a median 3.8 years of follow up, 125 of 638 (19.6%) participants with and 657 of 4,038 (16.3%) without elevated depressive symptoms had events. Higher risk of MI or death was observed for elevated depressive symptoms after adjusting for demographic data (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.15 to 1.72) but was no longer significant after adjusting for behavioral mechanisms (HR: 1.14, 95% CI: 0.93 to 1.40). The 4 behavioral mechanisms together significantly attenuated the risk for MI or death conveyed by elevated depressive symptoms (−36.9%, 95% CI: −18.9 to −119.1%), with smoking (−17.6%, 95% CI: −6.5% to −56.0%) and physical inactivity (−21.0%, 95% CI: −9.7% to −61.1%) having the biggest explanatory roles.
Conclusions Our findings suggest potential roles for behavioral interventions targeting smoking and physical inactivity in patients with CHD and comorbid depression.
This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data. The authors thank the other investigators, the staff, and the participants of the REGARDS (REason for Geographic and Racial Differences in Stroke) study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org. Dr. Ye is supported by an American College of Cardiology/Merck Research Fellowship award and by National Institutes of Health Grant T32HL007854-16. Dr. Safford receives salary support from Amgen, Inc., and Pfizer, Inc., for research studies; she has served as consultant for DiaDexus. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 4, 2012.
- Accepted September 21, 2012.
- American College of Cardiology Foundation