Depression may increase risk of midlife cardiovascular disease

Midlife women with depressive symptoms also exhibit progression of coronary artery calcification (CAC), researchers report in the American Heart Journal (2011;161(6):1186-1191).

Their study, an ancillary investigation of the Study of Women’s Health Across the Nation (SWAN), evaluated subclinical atherosclerosis in 346 women with no history of cardiovascular disease or diabetes.

Researchers measured CAC twice by electron beam computed tomography and assessed depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) Scale. CAC progression, defined as an increase of 10 or more Agatston units, occurred in 67 of the women. Each increase of 1 standard deviation in the baseline CES-D score was associated with a 25% rise in the risk of CAC progression (relative risk 1.25)-similar to the risks caused by body mass index (1.31) and systolic blood pressure (1.28)-independent of age, race, menopausal status, and known risk factors for cardiovascular disease.

The researchers note that treating depression may help prevent progression of CAC: Women with low CES-D scores who were taking medication for depression (that is, successfully treated) were no more likely to show CAC progression than women with the same CES-D scores who weren’t taking antidepressants. They advocate intervention studies to determine whether improved recognition and treatment of depression reduces progression of CAC in healthy people.

Forty-one percent of middle-aged women have some CAC and show an average increase of 13.2 Agatston units over 2 years, which translates into a 3-fold increase in cardiovascular disease, the researchers observe. They note that recent research indicates that CAC progression may predict cardiac events better than a single CAC measurement.