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A Report From the National Heart, Lung, and Blood Institute–Sponsored Women's Ischemia Syndrome Evaluation

Sarah E. Linke, MS; Thomas Rutledge, PhD; B. Delia Johnson, PhD; Viola Vaccarino, MD, PhD; Vera Bittner, MD, MSPH; Carol E. Cornell, PhD; Wafia Eteiba, MD; David S. Sheps, MD; David S. Krantz, PhD; Susmita Parashar, MD, MPH, MS; C. Noel Bairey Merz, MD

Arch Gen Psychiatry. 2009;66(5):499-507.

Context  Symptoms of depression and cardiovascular disease (CVD) overlap substantially. Differentiating between dimensions of depressive symptoms may improve our understanding of the relationship between depression and physical health.

Objective  To compare symptom dimensions of depression as predictors of cardiovascular-related death and events among women with suspected myocardial ischemia.

Design  Cohort study of women with suspected myocardial ischemia who underwent evaluation at baseline for a history of cardiovascular-related problems, depressive symptoms using the Beck Depression Inventory, and coronary artery disease severity via coronary angiography. Principal components analyses (PCAs) of the Beck Depression Inventory items were conducted to examine differential cardiovascular prognosis according to symptom dimensions of depression.

Setting  The Women's Ischemia Syndrome Evaluation (WISE), a multicenter study sponsored by the National Heart, Lung, and Blood Institute to assess cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia.

Participants  Five hundred fifty women (mean [SD] age, 58.4 [11.2] years) enrolled in the WISE study and followed up for a median of 5.8 years.

Main Outcome Measures  Cardiovascular-related mortality and events (stroke, myocardial infarction, and congestive heart failure).

Results  When a 3-factor structure from PCA was used, somatic/affective (hazards ratio, 1.35; 95% confidence interval, 1.04-1.74) and appetitive (1.42; 1.21-1.68) but not cognitive/affective (0.89; 0.70-1.14) symptoms predicted cardiovascular prognosis in adjusted multivariate Cox regression analysis. When a 2-factor structure from PCA was used, adjusted results indicated that somatic (hazards ratio, 1.63; 95% confidence interval, 1.28-2.08) but not cognitive/affective (0.87; 0.68-1.11) symptoms predicted worse prognosis.

Conclusions  In a sample of women with suspected myocardial ischemia, somatic but not cognitive/affective depressive symptoms were associated with an increased risk of cardiovascular-related mortality and events. These results support the need to research dimensions of depression in CVD populations and have implications for understanding the connection between depression and CVD.

Author Affiliations: Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (Ms Linke), Department of Psychiatry, University of California, San Diego (Dr Rutledge), and Psychology Service, Veterans Affairs San Diego Healthcare System (Dr Rutledge); Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Johnson and Eteiba); Divisions of Cardiology (Drs Vaccarino and Sheps), and General Medicine (Dr Parashar), Department of Medicine, Emory University School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Emory University (Dr Vaccarino), Atlanta, Georgia; Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (Dr Bittner); Department of Psychology, University of Arkansas for Medical Sciences, Little Rock (Dr Cornell); Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Krantz); and Women's Heart Center, Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Medical Center, Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Bairey Merz).

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