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Depression Is Associated With Cardiac Symptoms, Mortality Risk, and Hospitalization Among Women With Suspected Coronary Disease: The NHLBI-Sponsored WISE Study

From the University of California, San Diego, CA (T.R.); University of Pittsburgh, Pittsburgh, PA (S.E.R., M.R., J.O., S.F.K., K.A.S.); University of Florida, Gainesville, FL (C.J.P.); Allegheny General Hospital, Pittsburgh, PA (S.M.); University of Alabama, Birmingham, AL (W.J.R., C.E.C.); Cedars-Sinai Medical Center, Los Angeles, CA (C.N.B.M.); National Heart, Lung, & Blood Institute, Bethesda, MD (G.S.); and Rhode Island Hospital, Providence, RI (B.S.).

Address correspondence and reprint requests to Thomas Rutledge, PhD, Psychology Service 116B, VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: Thomas.Rutledge{at}med.va.gov

Objective: Depression is a robust predictor of cardiovascular risk. In this study, we examined the association between depression measured in terms of symptom severity and treatment history, cardiac symptom presentation, and clinical outcomes among a sample of women with suspected myocardial ischemia.

Methods: Seven hundred fifty women with chest pain, mean age 53.4, completed a diagnostic protocol including depression measures, coronary angiogram, ischemia testing, and coronary disease risk factor assessment. Five hundred five participants also completed the Beck Depression Inventory. We further tracked participants over a mean 2.3-year period to evaluate subsequent cardiac events, hospitalization, and mortality.

Results: Depression treatment history and current symptom severity were differentially associated with cardiac symptoms and outcomes. Both measures were reliably associated with coronary artery disease (CAD) risk factors and more severe cardiac symptoms. Depression symptom severity was linked to an increased mortality risk over follow-up (RR = 1.05; 95% CI, 1.01–1.09), whereas depression treatment history predicted an increased risk of hospitalization (RR = 1.3; 95% CI, 1.02–1.6), less severe CAD from angiogram, and a reduced likelihood of a positive ischemia test.

Conclusion: Among a sample of women with suspected myocardial ischemia, depression was associated with cardiac symptoms and health outcomes over follow-up. The findings extend the range of depression effects by demonstrating relationships within a sample of women experiencing symptoms of myocardial ischemia but showing a relative absence of flow limiting coronary stenoses. Depression measurements can assist the clinician in evaluating cardiac symptom presentation and cardiovascular risk status in women.

Key Words: women • CAD • depression • mortality • ischemia

Abbreviations: CAD = coronary artery disease; WISE = Women's Ischemia Syndrome Evaluation; BDI = Beck Depression Inventory.