Abstract 16285: Persistent or Worsening Depression is Associated With Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease (CAD)
Nishant Vatsa, Josiah Bennett, Sonika Vatsa, vardhmaan jain, Daniel Gold, Matthew Gold, Shivang Desai, Kiran Ejaz, Alireza Rahbar, Joy D Hartsfield, Yi-An Ko, Laurence Sperling, Puja K Mehta, Arshed A Quyyumi- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Depression has been associated with a higher risk of major adverse cardiovascular events (MACE). Whether a longitudinal change in depressive symptoms is associated with MACE in patients remains unknown.
Hypothesis: We hypothesized that increasing or persistent depression increases the risk of MACE in patients with CAD.
Methods: 5,479 participants with CAD enrolled in the Emory Cardiovascular Biobank (mean age 63.8 years, 39.9% female) were evaluated for baseline depression symptoms with the patient health questionnaire 9 (PHQ9). Depression was defined as PHQ9 >4. At one year, 1,286 participants completed follow-up PHQ9, and the PHQ9 change (1 year minus baseline score) was calculated. Cox models, adjusted for demographics, cardiovascular risk factors, medications, ejection fraction, CAD severity, and high sensitivity C-reactive protein levels, were performed to assess associations between PHQ9 and five-year MACE - a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, and nonfatal stroke.
Results: During five-year follow-up, there were 1067 (19.5%) MACE, with a 7.2% MACE rate after one year in the subset with follow-up depression data. Of the total, 38.8% were depressed at baseline and 23.6% at one year. Of participants with baseline depression, 34.8% had persistent depression at one year, whereas depression improved in the remaining. Among patients without baseline depression, 15.9% developed new depression at one year. A higher baseline PHQ9 score was associated with higher MACE rates (adjusted hazard ratio (HR): 1.02 [CI 1.00, 1.03], p=0.03). Overall, PHQ9 change independently predicted MACE (adjusted HR: 1.12 [1.05, 1.2], p=0.001); thus, participants with no change or increase in PHQ9 score were 96% (p=0.04) more likely to have MACE compared to those with a decrease in PHQ9 score after one year. Similarly, participants with new or persistent depression (PHQ9>4) at one year had a 59% (p=0.006) higher risk of MACE compared to those with absent or improved depression.
Conclusions: An increase or persistence of depressive symptoms predicts MACE in CAD. Whether treatment of depression will improve cardiovascular outcomes in this high-risk population needs further investigation.