Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study

Abstract

Objectives: We assessed the association between depression and sudden cardiac death (SCD) and cardiac events among individuals without baseline coronary heart disease (CHD).

Background: Depression is a risk factor for cardiac events and mortality among those with CHD, possibly from arrhythmia.

Methods: We studied depressive symptoms and a proxy variable for clinical depression consisting of severe symptoms and/or antidepressant medication use and their relationship to cardiac events in the Nurses' Health Study. Questionnaires in 1992, 1996, and 2000 assessed symptoms with the Mental Health Index (MHI-5), and antidepressant use was assessed in 1996 and 2000. Primary end points included SCD, fatal CHD, and nonfatal myocardial infarction.

Results: Among 63,469 women without prior CHD/stroke in 1992, 7.9% had MHI-5 scores <53, previously found to predict clinical depression. Depressive symptoms were associated with CHD events, and the relationship was strongest for fatal CHD, where the association remained significant even after controlling for CHD risk factors (hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.11 to 2.00 for MHI-5 score <53). In models from 1996 onward, our proxy variable for clinical depression was most associated with SCD in multivariable models (HR: 2.33, 95% CI: 1.47 to 3.70), and this risk was primarily due to a specific relationship between antidepressant use and SCD (HR: 3.34, 95% CI: 2.03 to 5.50).

Conclusions: In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD. Although antidepressant use might be a marker of worse depression, its specific association with SCD merits further study.

Figures

Figure 1

Distribution of MHI-5 score among 63,469 women without prior coronary heart disease, stroke, or cancer in 1992.

Figure 2

Unadjusted Kaplan-Meier curves of time to first event for sudden cardiac death (A), fatal coronary heart disease (B), and non-fatal myocardial infarction (C), according to depression status as defined by MHI-5 score

Figure 3

Unadjusted Kaplan-Meier curves of time to sudden cardiac death stratified by MHI-5 score