Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease

Whooley, Mary A.

doi:10.1001/jama.2008.711

Cited by 887Cardiac Health and Mental HealthCardiovascular Health and Risk FactorsPsychosomatic Disorders and Their Treatments

Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease

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Whooley, Mary A.·2008·JAMA

DOI 10.1001/jama.2008.711PMC PMC2677371

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Abstract

CONTEXT: Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown. OBJECTIVE: To determine why depressive symptoms are associated with an increased risk of cardiovascular events. DESIGN AND PARTICIPANTS: The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years. SETTING: Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008. MAIN OUTCOME MEASURES: Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators. RESULTS: A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score > or = 10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16-1.95; P = .002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00-1.71; P = .04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94-1.63; P = .12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79-1.40; P = .75). CONCLUSION: In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.

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Mechanisms linking psychosocial factors to increased CVD risk include unhealthy lifestyle, increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.
“Mechanisms that link psychosocial factors to increased CVD risk include unhealthy lifestyle (more frequent smoking, unhealthy food choice, and less physical exercise), increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.88,90,116 -119”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [119]

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Authors: Whooley, M. A.
Affiliations: San Francisco VA Medical Center (US)
Corresponding author: Whooley, Mary A.
ORCID: Whooley, Mary A.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2008-11-26
Volume: 300
Issue: 20
Pages: 2379
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2008.711
PMC: PMC2677371
OpenAlex: W2135398815
Cited by: 887
References: 83
Citations by year: 2026: 26 · 2025: 28 · 2024: 31 · 2023: 69 · 2022: 37 · 2021: 20 · 2020: 36 · 2019: 39 · 2018: 42 · 2017: 40 · 2016: 68 · 2015: 52 · 2014: 48 · 2013: 77 · 2012: 82
FWCI: 46.26
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL079235)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: depressive symptoms, coronary artery disease, cardiovascular events, heart failure, myocardial infarction, stroke, physical inactivity, health behavior, biological mediators, disease severity, mediation analysis, Heart and Soul Study, Patient Health Questionnaire, depression and cardiovascular risk, transient ischemic attack, mortality, comorbidities, physical activity, psychosocial risks
MeSH terms: Aged, Antidepressive Agents, Coronary Disease, Depression, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Severity of Illness Index, Health Behavior, Exercise, Comorbidity, Proportional Hazards Models

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Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease

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