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Depression and Risk of Heart Failure Among the Elderly: A Prospective Community-Based Study

Williams, Setareh A. PhD; Kasl, Stanislav V. PhD; Heiat, Asefeh MD; Abramson, Jerome L. PhD; Krumholz, Harlan M. MD, and; Vaccarino, Viola MD, PhD

Original Article

Objective Although the association between depression and the incidence of coronary heart disease has been established in many studies, the impact of depression on the incidence of heart failure has not been previously investigated.

Methods We examined the effect of depression (assessed by means of the Center for Epidemiological Studies Depression Scale (CES-D) with a cutoff point of ≥21) on the incidence of heart failure in a community sample of persons aged ≥65 years who were participants in the New Haven cohort of the Established Populations for Epidemiological Studies in the Elderly.

Results At baseline 2501 individuals were free of heart failure. Of these, 188 (132 women and 56 men) scored as depressed. Depressed participants were significantly more likely to have hypertension, diabetes, and mobility-related functional limitations and were less likely to be male or married. During the 14-year follow-up period, 313 participants (146 men and 167 women) developed heart failure, defined as hospital admission for heart failure or mortality with heart failure as the underlying cause of death. After adjusting for baseline differences in demographic and comorbidity factors and functional status using Cox regression, depression tended to be associated with a greater risk of heart failure (hazard ratio (HR) = 1.52, 95% confidence interval (CI) = 0.94–2.43, p = .09). This effect was significant in women (HR = 1.96, 95% CI = 1.11–3.46, p = .02) but not in men (HR = 0.62, 95% CI = 0.23–1.71, p = .05 for the interaction term between sex and depression).

Conclusions Depression is an independent risk factor for heart failure among elderly women but not elderly men.

From the Department of Epidemiology and Public Health (S.A.W., S.V.K., A.H., H.M.K.), and the Department of Medicine, Section of Cardiovascular Medicine (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Department of Preventive Medicine, Griffin Hospital, Derby, CT (A.H.); and Department of Medicine (J.L.A., V.V.), Division of Cardiology, Emory University School of Medicine, Atlanta, GA.

Address reprint requests to: Viola Vaccarino, MD, PhD, Emory University School of Medicine, Department of Medicine, Division of Cardiology, 1256 Briarcliff Road NE, Suite 1-North, Atlanta, GA 30306. Email:

Received for publication January 9, 2001; revision received May 8, 2001.

Copyright © 2002 by American Psychosomatic Society
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