Greater Risk for Adverse Cardiovascular Events Seen in Blacks With Depressive Symptoms

In a community-based cohort study, blacks with depressive symptoms were more likely to have higher incidences of stroke and coronary heart disease.

Major depressive symptoms were associated with greater risks of incident stroke and coronary heart disease (CHD) in a study conducted in a black population.

Because most studies that have examined the relationship between depression and cardiovascular risk were performed in white populations, researchers investigated the same relationship in a community-based cohort of blacks.

Using data from the Jackson Heart Study from 2000 to 2004, they found there was a 2-fold greater hazard of (hazard ratio [HR] 1.95; 95% CI, 1.02 – 3.71; P=.04) among patients with major depressive symptoms.

Patients were selected based on completion of at least 16 of the 20 Center for Epidemiological Studies Depression (CES-D) scale screening questions. Those who had a history of stroke or CHD were excluded from the study. The final cohort (N=3309) included 738 participants (22.3%) who had depressive symptoms at baseline (median age, 54.3 years; 63% women) from 4 populations in the Jackson, Mississippi, area.

Researchers also found that median BMI and waist circumference were higher among those with depressive symptoms, and antidepressant use was low among the same patients.

The findings for the unadjusted 10-year cumulative incidence of stroke were 3.7% (95% CI, 2.4% – 5.8%) for patients with depressive symptoms and 2.6% (95% CI, 2.0% – 3.4%) for patients without depressive symptoms (P=.12). Participants with major depressive symptoms showed the highest 10-year cumulative incidence rates of stroke (5.4%; 95% CI, 3.1% -9.4%). Interestingly, those with no depressive symptoms had higher incidence rates of stroke (2.6%; 95%, 2.0% – 3.4%) compared with those with minor depressive symptoms (2.0%; 95% CI, 1.0% – 4.3%).

For CHD, the 10-year cumulative incidence was 5.6% (95% CI, 4.0% -7.8%) for patients with depressive symptoms and 3.6% (95% CI, 2.9%- 4.6%) for those patients without depressive symptoms (P=.03). The highest incidence occurred in those with major depressive symptoms (5.8%; 95% CI, 3.7% – 9.0%), followed by those with minor depressive symptoms (5.3%; 95% CI, 3.2% – 8.8%).  Those without depressive symptoms had an incidence rate of 3.6% (95% CI, 2.9% – 4.6%; P=.06).

The researchers noted that the difference in increased risk between patients with major and minor depressive symptoms was consistent with previous studies.

However, this study did have some limitations: The researchers did not have access to changes in depressive symptomatology over time. While the CES-D is considered a validated screening tool for depressive symptomatology, misclassification of depression status may have occurred because researchers did not have information on clinically diagnosed depression.

“The need for greater understanding of associations between depressive symptoms and cardiovascular outcomes in blacks is particularly salient in light of reported racial disparities in disease severity, timely diagnosis, and the use of pharmacotherapy,” the researchers concluded.


O’Brien EC, Greiner MA, Sims M, et al. Depressive Symptoms and Risk of Cardiovascular Events in Blacks: Findings From the Jackson Heart Study. Circ Cardiovasc Qual Outcomes. 2015;8:552-559; doi:10.1161/CIRCOUTCOMES.115.001800.