SEX DIFFERENCES IN DEPRESSION AS AN INDEPENDENT RISK FACTOR FOR MORTALITY IN PATIENTS WITHOUT EXISTING CARDIOVASCULAR DISEASE AND IMPLICATIONS FOR THE DEVELOPMENT OF TAILORED INTERVENTIONS

摘要

Background: The prevalence of psychological disorders including depression are higher in women than in men. Depression is a risk factor for cardiovascular disease (CVD), major adverse cardiovascular events (MACE) and death. Whether there is a sex difference in mortality and MACE risk related to depression is not known. Objectives: This study assessed sex differences in the relationships between depression and mortality and MACE risk among patients with and without CVD. Methods: Analyses were undertaken using the DECADE (Depression Effects on Coronary Artery Disease Events) cohort of patients referred for CVD assessment (recruited 1998-2002). Depression was assessed using the PRIME-MD. Patients were followed for M=8.8 years. Outcome data were obtained from provincial healthcare databases. Relative risk ratios (RR) were calculated; analyses were stratified by sex and CVD history, and adjusted for age, smoking, diabetes, hypertension, dyslipidemia, exercise- induced myocardial ischemia and BMI. Results: Of 2390 participants, 46% had existing CVD, 33% were women, 24% had a depression diagnosis. In women (but not men) without CVD, depression was related to a higher risk of mortality (RR=14.4, 95%CI = 1.9-107.7) but not MACE (RR=1.5, 95%CI=0.6-4.4). No relationships were observed for depression and either mortality or MACE in patients with CVD for both sexes. Conclusion: In women without existing CVD, depression was an independent risk factor for all-cause mortality. Further work is needed to untangle the potential mechanisms which may underlie this, leading to the development of behavioural interventions to improve outcomes in women with depression.