Sex Differences in the Association Between Depression and Incident Cardiovascular Disease

Overview

Journal JACC Asia

Date 2024 Apr 25

PMID 38660110

Authors

Keitaro Senoo

Hidehiro Kaneko

Kensuke Ueno

Yuta Suzuki

Akira Okada

Katsuhito Fujiu

Taisuke Jo

Norifumi Takeda

Hiroyuki Morita

Kentaro Kamiya

Junya Ako

Koichi Node

Hideo Yasunaga

Issei Komuro

Affiliations

Soon will be listed here.

Abstract

Background: Depression is a known risk factor for cardiovascular disease (CVD), but the potential sex differences in this association remain unclear.

Objectives: The aim of this study was to investigate the association between depression and subsequent CVD events, and to explore potential sex differences.

Methods: The authors conducted a retrospective analysis using the JMDC Claims Database between 2005 and 2022. The study population included 4,125,720 individuals aged 18 to 75 years without a history of cardiovascular disease or renal failure and missing data at baseline. Participants were followed up for a mean of 1,288 days to assess the association between depression and subsequent CVD events, such as myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation.

Results: Our analysis revealed a significant association between depression and subsequent composite CVD events in both men and women, with a stronger association observed in women. The HR for the composite endpoint was 1.64 (95% CI: 1.59-1.70) in women and 1.39 (95% CI: 1.35-1.42) in men after multivariable adjustment ( for interaction <0.001). Furthermore, the individual components of the composite endpoint were also associated with depression in both men and women, each of which was also observed to be more strongly associated in women.

Conclusions: Our study provides evidence of a significant association between depression and subsequent CVD events in both men and women, with a more pronounced association observed in women. These findings highlight the importance of addressing depression and tailoring prevention and management strategies according to sex-specific factors.

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References

Aloisio K, Swanson S, Micali N, Field A, Horton N . Analysis of partially observed clustered data using generalized estimating equations and multiple imputation. Stata J. 2015; 14(4):863-883. PMC: 4306281. View

Saito I, Yamagishi K, Kokubo Y, Yatsuya H, Iso H, Sawada N . Association between mortality and incidence rates of coronary heart disease and stroke: The Japan Public Health Center-based prospective (JPHC) study. Int J Cardiol. 2016; 222:281-286. DOI: 10.1016/j.ijcard.2016.07.222. View

Albert P . Why is depression more prevalent in women?. J Psychiatry Neurosci. 2015; 40(4):219-21. PMC: 4478054. DOI: 10.1503/jpn.150205. View

Bertakis K, Helms L, CALLAHAN E, Azari R, Leigh P, Robbins J . Patient gender differences in the diagnosis of depression in primary care. J Womens Health Gend Based Med. 2001; 10(7):689-98. DOI: 10.1089/15246090152563579. View

Kim S, Jeong I . Sex differences in the relationship between depression and cardiovascular disease risk: a nationwide study in Korea. Osong Public Health Res Perspect. 2021; 12(2):105-114. PMC: 8102882. DOI: 10.24171/j.phrp.2021.12.2.08. View

Miura K, Nakagawa H, Ohashi Y, Harada A, Taguri M, Kushiro T . Four blood pressure indexes and the risk of stroke and myocardial infarction in Japanese men and women: a meta-analysis of 16 cohort studies. Circulation. 2009; 119(14):1892-8. DOI: 10.1161/CIRCULATIONAHA.108.823112. View

Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A . Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J. 2015; 37(1):24-34. DOI: 10.1093/eurheartj/ehv598. View

Meng R, Yu C, Liu N, He M, Lv J, Guo Y . Association of Depression With All-Cause and Cardiovascular Disease Mortality Among Adults in China. JAMA Netw Open. 2020; 3(2):e1921043. PMC: 7212017. DOI: 10.1001/jamanetworkopen.2019.21043. View

Matsuoka S, Kaneko H, Yano Y, Itoh H, Fukui A, Morita K . Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis. Am J Hypertens. 2021; 34(10):1049-1056. DOI: 10.1093/ajh/hpab074. View

10.

Haukkala A, Konttinen H, Uutela A, Kawachi I, Laatikainen T . Gender differences in the associations between depressive symptoms, cardiovascular diseases, and all-cause mortality. Ann Epidemiol. 2009; 19(9):623-9. DOI: 10.1016/j.annepidem.2009.01.010. View

11.

Blaber M, Khan J, Brebner J, McColm R . "Lipid rescue" for tricyclic antidepressant cardiotoxicity. J Emerg Med. 2012; 43(3):465-7. DOI: 10.1016/j.jemermed.2011.09.010. View

12.

Moller-Leimkuhler A . Gender differences in cardiovascular disease and comorbid depression. Dialogues Clin Neurosci. 2007; 9(1):71-83. PMC: 3181845. View

13.

Perez-Lopez F, Larrad-Mur L, Kallen A, Chedraui P, Taylor H . Gender differences in cardiovascular disease: hormonal and biochemical influences. Reprod Sci. 2010; 17(6):511-31. PMC: 3107852. DOI: 10.1177/1933719110367829. View

14.

Austin P, Lee D, Fine J . Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016; 133(6):601-9. PMC: 4741409. DOI: 10.1161/CIRCULATIONAHA.115.017719. View

15.

Moscucci F, Gallina S, Bucciarelli V, Aimo A, Pela G, Cadeddu-Dessalvi C . Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on 'gender cardiovascular diseases'. J Cardiovasc Med (Hagerstown). 2023; 24(Suppl 1):e15-e23. PMC: 10100638. DOI: 10.2459/JCM.0000000000001398. View

16.

Bromberger J, Kravitz H . Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011; 38(3):609-25. PMC: 3197240. DOI: 10.1016/j.ogc.2011.05.011. View

17.

Elovainio M, Hakulinen C, Pulkki-Raback L, Virtanen M, Josefsson K, Jokela M . Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. Lancet Public Health. 2017; 2(6):e260-e266. PMC: 5463031. DOI: 10.1016/S2468-2667(17)30075-0. View

18.

Grote N, Zuckoff A, Swartz H, Bledsoe S, Geibel S . Engaging women who are depressed and economically disadvantaged in mental health treatment. Soc Work. 2008; 52(4):295-308. PMC: 3025777. DOI: 10.1093/sw/52.4.295. View

19.

Morita K, Ono S, Ishimaru M, Matsui H, Naruse T, Yasunaga H . Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan. J Am Geriatr Soc. 2018; 66(4):728-734. DOI: 10.1111/jgs.15295. View

20.

Berkman L, Blumenthal J, Burg M, Carney R, Catellier D, Cowan M . Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003; 289(23):3106-16. DOI: 10.1001/jama.289.23.3106. View