Study data published in the Journal of Psychosomatic Research identified an increased risk for cardiovascular disease in patients with depression. The association was most significant in patients with clinically relevant depressive symptoms. Patients with controlled depression did not have elevated cardiovascular risk compared with control participants.
This retrospective study enrolled patients with a primary care encounter between 2016 and 2018 at participating centers in Minnesota and Wisconsin. Patients were retained for the present analysis if they had completed the Patient Health Questionnaire-9 (PHQ-9) in the year prior to their care encounter. Per PHQ-9 scores, patients were classified into the following groups: (1) no depression; (2) depression diagnosis with currently controlled symptoms; and (3) active depression.
Demographic data, mental health data, and cardiovascular risk data were abstracted from electronic medical records. Cardiovascular risk was calculated using 2 equations: 1 estimated the likelihood of having a fatal or nonfatal atherosclerotic CVD event in the next 10 years; the other estimated the 30-year risk. Risk equations incorporated demographic data and risk factors, including blood pressure, lipid levels, diabetes status, smoking status, and body mass index (BMI). Logistic regression models were used to estimate total and specific cardiovascular risk among patients with depression compared with patients without depression.
The study cohort comprised 70,980 patients: 18,267 (24.1%) with current depression; 33,383 (47.0%) with controlled depression; and 19,330 (27.2%) with no depression. Patients with current depression were younger, more often women, and less often White compared with other patient groups (all P <.001).
In analyses adjusted for age, sex race/ethnicity, and insurance type, patients with current depression had a significantly elevated 30-year risk for cardiovascular events compared with patients with controlled depression (odds ratio [OR], 1.1.18; 95% CI, 1.13-1.24) and patients without depression (OR, 1.56; 95% CI, 1.48-1.65). The 10-year risk was also substantially elevated compared with patients without depression (OR, 1.56; 95% CI, 1.48-1.65), though not compared with patients with controlled depression.
Patients with current depression were also more likely to have certain cardiovascular risk factors. Specifically, patients with current depression were more likely to have a current diagnosis of coronary heart disease or cardiovascular disease than their counterparts without current depression. Patients with current depression had significantly higher triglycerides and lower high-density lipoprotein than patients with controlled depression or no depression. Current depression was further associated with higher BMI, greater odds of current smoking, and greater odds of a current diabetes mellitus diagnosis.
These results suggest that the treatment of depression, in addition to uncontrolled cardiovascular risk factors, is essential in mitigating cardiovascular risk. Study limitations include the cross-sectional design and the exclusion of patients without PHQ-9 data, which may have introduced selection bias to the depression cohort.
“[Further] clinical and research efforts are needed to ascertain mechanisms, determine causality, further examine moderators…and establish best approaches for reducing cardiovascular risk in patients with current depression,” the investigators wrote.
Hooker SA, O’Connor PJ, Sperl-Hillen JM, et al. Depression and cardiovascular risk in primary care patients. J Psychosom Res. Published online April 19, 2022. doi:10.1016/j.jpsychores.2022.110920