Depression Raises Heart Failure Rate in Elderly Women

A new study shows that depression is associated with an increased incidence of heart failure in elderly women, but not elderly men.

Although previous studies have shown that depression predicts a higher risk of death in patients with heart failure, this is the first study to show that depression actually increases the risk of developing heart failure in community elderly persons, says study author Viola Vaccarino, M.D., Ph.D., of Emory University School of Medicine.

Women who screened positive for depression at the beginning of the study were nearly twice as likely to develop heart failure during the 14 years of follow up, according the results published in the January issue of Psychosomatic Medicine. Heart failure occurs when ineffective pumping of the heart leads to an accumulation of fluid in the lungs.

The study included 2,501 participants, including 1,047 men and 1,454 women, with an average age of 74 at entry. Slightly more than 5 percent of the men were depressed at the beginning of the study, compared with 9 percent of the women. Over the 14 years, 313 subjects developed heart failure.

Nineteen percent of the depressed women developed heart failure during the course of the study, compared with 10 percent of the non-depressed women. In contrast, 12 percent of the depressed men developed heart failure compared with 15 percent of the non-depressed men, although this difference was not statistically significant.

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Subjects who were depressed were also more likely to have physical illnesses such as hypertension, diabetes and mobility limitations, all of which are also risk factors for heart diseases. However, taking these factors into account, depression still increased the incidence of heart failure.

The researchers suggest that depression may increase heart failure risk through biological pathways, such as the neuroendocrine system, or through behavioral mechanisms, such as poor adherence to drug regimens.

The lesser association between depression and heart failure among men in this elderly cohort may have been due to the tendency of men to develop heart disease much earlier than women. Another possible explanation is that women may have a stronger physiological response to depression than men, thereby significantly increasing their risk of heart failure, the researchers note.

The presence of depressed mood should alert clinicians to a higher risk of not only ischemic heart disease but also [heart failure] in their patients, they say. Early diagnosis and treatment of depression may reduce the burden of morbidity and mortality due to HF in the elderly and reduce the public health costs associated with HF treatment.

The study was supported by a grant from the National Institute of Mental Health. Psychosomatic Medicine is the official bimonthly peer-reviewed journal of the American Psychosomatic Society. For information about the journal, contact Joel E. Dimsdale, M.D., at (619) 543-5468. Release provided by the Center for the Advancement of Health .

Source: Center for the Advancement of Health