The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease.

Authors

Nishant Vatsa, Emory University
Josiah Bennett, Emory University
Sonika Vatsa, Rowan University
Alireza Rahbar, Emory University
Daniel A Gold, Emory University
Vardhmaan Jain, Emory University
Matthew E Gold, Emory University
Alexander Razavi, Emory University
Adithya Yadalam, Emory University
Shivang Desai, Emory University
Muhammad Owais, Emory University
Joy D Hartsfield, Emory University
Yi-An Ko, Emory University
Laurence Sperling, Emory University
Viola Vaccarino, Emory University
Puja K Mehta, Emory University
Arshed A Quyyumi, Emory University

Document Type

Article

Version Deposited

Published Version

Publication Date

10-24-2024

Publication Title

JACC: Advances

DOI

10.1016/j.jacadv.2024.101348

Abstract

BACKGROUND: Depression is associated with major adverse cardiovascular events (MACE). Whether longitudinal changes in depression affect MACE in patients with coronary heart disease (CHD) remains unknown.

OBJECTIVES: The authors evaluated the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.

METHODS: At baseline, 3,483 Emory Cardiovascular Biobank participants (median age 65.5 years, 31.6% female) completed the Patient Health Questionnaire 8 (PHQ8) for depression evaluation. At 1 year, 2,639 of these event-free participants repeated the questionnaire. Depression was defined as a PHQ8 score >9 and change in depressive symptoms (Δ" role="presentation"> PHQ8) was year 1 score minus baseline PHQ8 scores. We categorized participants into never depression (both PHQ8 <10), new depression (baseline PHQ8 <10; 1-year PHQ8 >9), remitted depression (baseline PHQ8 >9; year 1 PHQ8 <10), and persistent depression (both PHQ8 >9) groups. Fine-Gray models with noncardiovascular death as the competing event and adjusted for demographics, CHD, and depression related factors evaluated how changes in depression affect MACE (cardiovascular death and MI).

RESULTS: Overall, the incidence of MACE was 14%, with 8.7% of those with follow-up PHQ8 having MACE. 2.9% had persistent depression, 4.5% had new depression, 10.8% had remitted depression, and 81.8% never had depression. Increasing depressive symptoms independently predicted MACE (Δ" role="presentation"> PHQ8 subdistribution HR: 1.06 [95% CI: 1.02-1.09], P < 0.001). Correspondingly, the incidence of MACE was higher in those with persistent (20.8%) or new depression (11.9%) than in those with remitted (9.4%) or never depression (8%) (P < 0.001). Compared to never depression, persistent depression independently predicted MACE (subdistribution HR: 2.78 [95% CI: 1.2-6.5], P = 0.017).

CONCLUSIONS: Increasing or persistent depression predicts MACE in individuals with CHD.

Recommended Citation

Vatsa, Nishant; Bennett, Josiah; Vatsa, Sonika; Rahbar, Alireza; Gold, Daniel A; Jain, Vardhmaan; Gold, Matthew E; Razavi, Alexander; Yadalam, Adithya; Desai, Shivang; Owais, Muhammad; Hartsfield, Joy D; Ko, Yi-An; Sperling, Laurence; Vaccarino, Viola; Mehta, Puja K; and Quyyumi, Arshed A, "The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease." (2024). Rowan-Virtua School of Osteopathic Medicine Departmental Research. 247.
https://rdw.rowan.edu/som_facpub/247

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Published Citation

Vatsa N, Bennett J, Vatsa S, Rahbar A, Gold DA, Jain V, Gold ME, Razavi A, Yadalam A, Desai S, Owais M, Hartsfield JD, Ko YA, Sperling L, Vaccarino V, Mehta PK, Quyyumi AA. The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease. JACC Adv. 2024 Oct 24;3(11):101348. doi: 10.1016/j.jacadv.2024.101348. PMID: 39513130; PMCID: PMC11541773.