Objective: To test the hypothesis that African American and white women with recurrent major depression would show greater progression of coronary artery calcification (CAC) than would women with a single episode or no episode of major depression. Depressive symptoms and major depression are risk factors for clinical coronary heart disease (CHD) among CHD patients and among healthy individuals. It is less clear whether depression is related to the progression of atherosclerosis before the onset of CHD events.
Design: Longitudinal cohort study.
Methods: A total of 149 middle-aged healthy women (n = 113 white and 36 African American) who reported no heart disease, stroke, or diabetes were enrolled simultaneously in two ancillary studies of the Study of Women's Health Across the Nation at the Pittsburgh site: the Mental Health Study and the Study of Women's Health Across the Nation Heart Study. These women were administered psychiatric interviews annually and CAC computed tomography measures on two occasions approximately 2¼ years apart.
Results: Women who had recurrent major depression (n = 33) had greater progression of CAC (logged difference scores) than did women with a single or no episodes, b = 0.09 (0.04), p = .01. The other significant covariates were body mass index, systolic blood pressure, initial CAC, and time between scans. Stratified analyses showed that the effect was obtained in those women who had any CAC on the first examination.
Conclusions: Recurrent major depression may be a risk factor for progression of atherosclerosis, especially in those who have at least some initial calcification. Women with a history of depression may be candidates for aggressive cardiovascular risk factor prevention therapy.
SWAN = Study of Women's Health Across the Nation; CAC = coronary artery calcification; BMI = body mass index; SBP = systolic blood pressure; CHD = coronary heart disease; CRP = C-reactive protein; SCID-IV = structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition axis I disorders; CES-D = Center for Epidemiological Studies Depression scale; CVD = cardiovascular disease; EBT = electron beam tomography; HDL-C = high-density lipoprotein cholesterol.