Depression linked to higher heart disease death risk in younger women

 Women  55 and younger are twice as likely to suffer a heart attack, die or require artery-opening procedures if they're moderately or severely depressed, according to new research in the Journal of the American Heart Association.

''Women in this age group are also more likely to have depression, so this may be one of the 'hidden' risk factors that can help explain why women die at a disproportionately higher rate than men after a heart attack,'' said Amit Shah, M.D., M.S.C.R., study author and assistant professor of Epidemiology at Emory University in Atlanta, Ga.

Investigators assessed depression symptoms in 3,237 people with known or suspected heart disease (34 percent women, average age 62.5 years) scheduled for coronary angiography, an X-ray that diagnoses disease in the arteries that supply blood to the heart. After nearly three years of follow-up, researchers found:

• In women 55 and younger, after adjusting for other heart disease risk factors, each 1-point increase in symptoms of depression was associated with a 7 percent increase in the presence of heart disease.
• In men and older women, symptoms of depression didn't predict the presence of heart disease.
• Women 55 and younger were 2.17 times as likely to suffer a heart attack, die of heart disease or require an artery-opening procedure during the follow-up period if they had moderate or severe depression.
• Women 55 and younger were 2.45 times as likely to die from any cause during the follow-up period if they had moderate or severe depression.

''All people, and especially younger women, need to take depression very seriously,'' Shah said. ''Depression itself is a reason to take action, but knowing that it is associated with an increased risk of heart disease and death should motivate people to seek help.''

''Providers need to ask more questions. They need to be aware that young women are especially vulnerable to depression, and that depression may increase the risk to their heart,'' Shah said.

''Although the risks and benefits of routine screening for depression are still unclear, our study suggests that young women may benefit for special consideration'' remarked Viola Vaccarino, M.D., Ph.D., senior author of the study and Wilton Looney Chair of Epidemiology at Emory University. ''Unfortunately, this group has largely been understudied before.''

In 2008, the American Heart Association issued a scientific statement recommending that depression be formally considered as a risk factor, like diabetes or hypertension, for increased heart disease risk. ''Our data are in accordance with this recommendation, but suggest that young/middle aged women may be especially vulnerable to depression as a risk factor,'' Vaccarino added.''

The research group is examining whether women have more cardiovascular changes than men in response to a short-term mental stress, such as giving a public speech.

Co-authors are Nima Ghasemzadeh, M.D.; Elisa Zaragoza-Macias, M.D.; Riyaz Patel, M.D.; Danny J. Eapen, M.D.; Ian J. Neeland, M.D.; Pratik M. Pimple, M.B.B.S., M.P.H.; A. Maziar Zafari, M.D., Ph.D.; Arshed A. Quyyumi, M.D.; and Viola Vaccarino, M.D., Ph.D. Author disclosures are on the manuscript.

The National Institutes of Health and Emory Heart and Vascular Center funded the study.