This article is more than 5 years old. Information may no longer be current.
Long-term depression may increase stroke risk regardless of treatment
Long-term depressive symptoms are associated with increased risk for stroke, and this association persists even if the depressive symptoms remit, according to new findings.
Researchers evaluated 16,178 participants in the Health and Retirement Study (mean age, 65.7 years; 41.5% men; 78.2% white) who were aged at least 50 years, stroke-free and not institutionalized at baseline. Participants were interviewed biennially from 1998 to 2010.
Paola Gilsanz, ScD, and colleagues assessed strokes through self-report of doctors’ diagnoses, and measured depressive symptoms using a modified Center for Epidemiologic Studies Depression Scale (CES-D), with the presence of three or more symptoms defined as a high level of depression.
The researchers then examined whether depressive symptom patterns —characterized across two interviews as “stable low/no,” “onset,” “remitted” or “stable high” — were predictive of incident stroke during the subsequent 2 years after adjustment for demographics, health behaviors, chronic conditions and attrition, and they estimated the effects stratified according to age, race/ethnicity and sex.
Gilsanz, a Yerby postdoctoral research fellow at Harvard University’s T.H. Chan School of Public Health, and colleagues observed 1,192 strokes during the study period (mean follow-up, 8.88 years).
They found that, compared with those who had stable low/no depressive systems, participants with stable high depressive symptoms had elevated risk for stroke (adjusted HR = 2.14; 95% CI, 1.69-2.71), as did those with remitted depressive symptoms (adjusted HR = 1.66; 95% CI, 1.22-2.26). The risk for stroke was not significantly different between those with stable high or remitted symptoms.
Stable high depressive symptoms were associated with higher stroke risk across all age, sex and race/ethnicity subgroups. Remitted depressive symptoms were associated with higher stroke risk in women (adjusted HR = 1.86; 95% CI, 1.3-2.66) and non-Hispanic whites (adjusted HR = 1.66; 95% CI, 1.18-2.33), and marginally so in Hispanics (adjusted HR = 2.36; 95% CI, 0.98-5.67).
“Looking at how changes in depressive systems over time may be associated with strokes allowed us to see if the risk of stroke increases after elevated depressive symptoms start or if risk goes away when depressive symptoms do,” Gilsanz said in a press release. “We were surprised that changes in depressive symptoms seem to take more than 2 years to protect against or elevate stroke risk.”
Possible mechanisms for the association between depression and stroke include depressive phenotypes being linked to physiological risk factors such as hypertension, dysregulation of the autonomic nervous system and increased inflammatory responses; the indirect effects of depression on health behaviors such as smoking and physical inactivity; and depressive symptoms inducing stroke triggers such as infection or atrial fibrillation, the researchers wrote. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.