High levels of depressive symptoms tied to incident HF in Black women, not men

High depressive symptoms were associated with risk for incident HF among Black women, but not Black men, according to data published in the Journal of the American Heart Association.

“Among patients with HF, elevated depressive symptoms are associated with greater functional impairment and symptom burden, poor self-care, worse quality of life, hospitalization and death,” Allison E. Gaffey, PhD, instructor of cardiovascular medicine at Yale School of Medicine and clinical psychologist within the department of internal medicine, section of cardiovascular medicine and a clinician investigator in cardiovascular medicine and women’s health at the VA Connecticut Healthcare System, and colleagues wrote. “Black patients, in particular, are less likely to be diagnosed with a major depressive disorder or to receive treatment for depression, report higher levels of psychological distress, and experience greater functional impairment that is attributable to depression, compared with white patients. These data raise important questions about how depression leads to incident HF and possibly worse health outcomes in Black patients, and whether comorbid conditions, such as diabetes and hypertension, may affect this relationship.”

To investigate the relationship between depressive symptoms and incident HF, researchers evaluated 2,651 Black participants in the Jackson Heart Study (median age, 53 years; 64% women) with no HF at baseline. Depressive symptom severity was measured using the Center for Epidemiological Studies Depression score, with a score of 16 or more indicating high depressive symptoms and a score less than 16 indicating low symptoms. Researchers adjusted by sex, demographics, HF risk factors and lifestyle factors.

Association of depression and HF

Within the overall cohort, 20.3% of participants reported high depressive symptoms, 71% of whom were women. The cumulative incidence of HF was 0.06%.

Researchers reported that high depressive symptoms were associated with a 43% greater risk for incident HF compared with low depressive symptoms (HR = 1.43; 95% CI, 1.03-1.98; P = .035) and remained significant after adjustment for demographics (adjusted HR = 1.41; 95% CI, 1.04-2.05; P = .027) and HF risk factors (aHR = 1.44; 95% CI, 1.02-2.02; P = .036). However, the relationship between depressive symptoms and incident HF was no longer significant after adjustment for lifestyle factors (aHR = 1.23; 95% CI, 0.84-1.81; P = .28).

Depressive symptoms were not associated with all-cause death in this cohort (HR = 1.04; 95% CI, 0.81-1.32; P = .77).

HF and depression in women

Gaffey and colleagues observed that high depressive symptoms were associated with incident HF among women (HR = 1.52; 95% CI, 1.02-2.26; P = .039) but not men (HR = 1.26; 95% CI, 0.69-2.32; P = .45).

The association observed among women remained significant after adjustment for demographics, HF risk factors and lifestyle factors (aHR = 1.53; 95% CI, 1.01-2.3; P = .043).

“Our finding that greater depressive symptoms only conferred HF risk among Black women aligns with previous evidence highlighting women’s unique vulnerability to HF,” the researchers wrote. “The higher prevalence of depression among women is well documented. Systemic differences that drive this distinction may involve sex hormones; long-term elevations in sympathetic nervous system, inflammatory cytokine, and/or hypothalamic-pituitary-adrenal axis activity; and alterations in neurotrophic or metabolic factors, among others.

“Based on these data, screening for depression among Black adults, especially those with HF, may be warranted,” the researchers wrote