Depressive Symptoms Linked to Risk for Incident Heart Failure in Black Adult Patients

A senior African-American woman in her 70s at home sitting on a bed – furniture, looking out the window with a sad, lonely expression.
Investigators evaluated the association between depressive symptoms, incident heart failure, and all-cause mortality in Black patients.

Sex-specific associations between symptoms of depression and incident heart failure (HF) have been reported among Black adults, with a higher risk observed among Black women. These findings were published in the Journal of the American Heart Association.

A secondary analysis of Black patients from the single-site, community-based Jackson Heart Study was conducted. The original JHS study cohort comprised individuals who resided in the Jackson, Mississippi, metropolitan area and was designed to explore risk factors for cardiovascular disease (CVD).

Recognizing that sparse data are available from racial minorities and that depression is underrecognized and undertreated in the Black population, the investigators of the study sought to evaluate the relationship among baseline depressive symptoms, incident HF, and all-cause mortality across 10 years. Participants from the Jackson Heart Study with no history of HF at baseline were included in the secondary analysis.

A total of 2651 individuals were enrolled in the final analytic sample. The participants were median aged 53 years and 63.9% were women. Cox proportional hazards models were used to examine whether the risk for incident HF or mortality varied according to clinically significant depressive symptoms at baseline (Center for Epidemiological Studies–Depression [CES-D] scores of ≥16 vs <16). Self-reported disease and clinical measurement during baseline examination were used to obtain participants’ initial HF status.

All of the participants completed a baseline examination between 2000 and 2004, including medical history and physical examination; survey of demographic and socioeconomic characteristics and lifestyle factors (ie, smoking status, height/weight, alcohol use disorder, physical activity); blood and urine analysis; and CVD assessment.

The primary study outcomes included HF hospitalization and all-cause mortality and both outcomes were time-varying. The time to hospitalization outcome classification began on January 1, 2005, which was when HF hospitalization surveillance was initiated in the Jackson Heart Study cohort. Further, time to death was calculated from the date of each baseline examination.

Overall, 20.3% of the participants reported high levels of depressive symptoms. Of these individuals, 71.0% were women, and 181 cases of HF were reported (cumulative incidence, 0.06%; 95% CI, 0.05%-0.07%). The cumulative incidence of all-cause mortality was 0.05% among 293 cases (95% CI, 0.04%-0.05%).

Results of the study showed that the cumulative incidence of HF was significantly higher among those with high vs low levels of depressive symptoms (0.07%; 95% CI, 0.05%-0.09% vs 0.05%; 95% CI, 0.04%-0.06%, respectively; P =.030). In contrast, no significant difference in the cumulative incidence of all-cause mortality was observed between those with high vs low levels of depressive symptoms (0.04%; 95% CI, 0.03%-0.06% vs 0.05%; 95% CI, 0.04%-0.06%, respectively; P =.73).

In the unadjusted model, participants with high depressive symptoms experienced a 43% significantly greater risk for HF (P =.035). Although the relationship persisted with demographic and HF risk factors, it was attenuated by lifestyle factors. Based on sex, the unadjusted link between depressive symptoms and HF persisted for women only

(P =.039). Further, in the fully adjusted model, a 53% greater risk for HF was reported among those women with high levels of depressive symptoms (P =.043).

A major limitation of the current study is the fact that although the CES-D scale was designed to measure the current level of depressive symptoms, it did not capture sufficiently the features needed for a diagnosis of major depressive disorder.

“…in a sample of Black adults, high depressive symptoms were associated with risk of incident HF, which persisted after multivariable adjustment for clinical risk factors, but was eliminated after controlling for lifestyle factors,” the researchers wrote. “Future work is merited concerning changes in the sex-specific burden of depression over time and testing of algorithms for assessing and monitoring depression status, and for treating depression, as potential strategies to mitigate the associated risk of HF among Black men and women.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Gaffey AE, Cavanagh CE, Rosman L, et al. Depressive symptoms and incident heart failure in the Jackson Heart Study: differential risk among Black men and women.J Am Heart Assoc. Published online February 22, 2022. doi:10.1161/JAHA.121.022514