This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoen, P. W. Articles by de Jonge, P. Search for Related Content PubMed PubMed Citation Articles by Hoen, P. W. Articles by de Jonge, P. Related Collections Related Articles

CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Differential Associations Between Specific Depressive Symptoms and Cardiovascular Prognosis in Patients With Stable Coronary Heart Disease

Petra W. Hoen, BSc^_*,_*, Mary A. Whooley, MD^,||, Elisabeth J. Martens, PhD, Beeya Na, MPH, Joost P. van Melle, MD and Peter de Jonge, PhD^_*,

^_* Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
Department of Medical Psychology, Tilburg University, Tilburg, the Netherlands
San Francisco VA Medical Center, San Francisco, California
^|| University of California, San Francisco, California

Manuscript received July 22, 2009; revised manuscript received March 12, 2010, accepted March 23, 2010.

^_* Reprint requests and correspondence: Ms. Petra W. Hoen, Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, CC72, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands (Email: p.w.hoen{at}med.umcg.nl).

Objectives: The purpose of this research was to evaluate the relationship between cognitive and somatic depressive symptoms and cardiovascular prognosis.

Background: Depression in patients with stable coronary heart disease (CHD) is associated with poor cardiac prognosis. Whether certain depressive symptoms are more cardiotoxic than others is unknown.

Methods: In the Heart and Soul Study, 1,019 patients with stable CHD were assessed using the Patient Health Questionnaire to determine the presence of the 9 depressive symptoms included in the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition. The mean age of the patients was 67 years, and 82% were men. A comparison was made on a new cardiovascular event (myocardial infarction, stroke, transient ischemic attack, or congestive heart failure) or death (mean follow-up duration 6.1 ± 2.0 years) on the basis of cognitive and somatic sum scores and for patients with or without each of those specific depressive symptoms. Demographic characteristics, cardiac risk factors, and cardiac medications were controlled for.

Results: After adjustment for demographic data and cardiac risk factors, each somatic symptom was associated with 14% greater risk for events (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.05 to 1.24; p = 0.002). Fatigue (HR: 1.34; 95% CI: 1.07 to 1.67; p = 0.01), appetite problems (HR: 1.46; 95% CI: 1.12 to 1.91; p = 0.005), and sleeping difficulties (HR: 1.26; 95% CI: 1.00 to 1.58; p = 0.05) were most strongly predictive of cardiovascular events. In contrast, cognitive symptoms (HR: 1.08; 95% CI: 0.99 to 1.17; p = 0.09) were not significantly associated with cardiovascular events.

Conclusions: In patients with stable CHD, somatic symptoms of depression were more strongly predictive of cardiovascular events than cognitive symptoms, although the CIs surrounding these estimates had substantial overlap. These findings are highly consistent with those of previous studies. Further research is needed to understand the pathophysiological processes by which somatic depressive symptoms contribute to prognosis in patients with CHD.

Key Words: depression • stable coronary heart disease and prognosis

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   CV = cardiovascular   HR = hazard ratio   MI = myocardial infarction   PHQ = Patient Health Questionnaire

Related Articles

Symptoms of Depression But Not Depressive Disorder

Eva R. Serber
J. Am. Coll. Cardiol. 2011 57: 1568. [Full Text] [PDF]

This article has been cited by other articles:

				R. M. Carney and K. E. Freedland Are Somatic Symptoms of Depression Better Predictors of Cardiac Events Than Cognitive Symptoms in Coronary Heart Disease? Psychosom Med, January 1, 2012; 74(1): 33 - 38. [Abstract] [Full Text] [PDF]

				E. R. Serber Symptoms of Depression But Not Depressive Disorder J. Am. Coll. Cardiol., April 5, 2011; 57(14): 1568 - 1568. [Full Text] [PDF]

				P. W. Hoen, M. A. Whooley, and P. de Jonge Reply J. Am. Coll. Cardiol., April 5, 2011; 57(14): 1568 - 1569. [Full Text] [PDF]

				Depression Is Linked to Cardiovascular Prognosis Journal Watch (General), October 14, 2010; 2010(1014): 3 - 3. [Full Text]