期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 4, 期 5, 页码 -出版社
WILEY-BLACKWELL
DOI: 10.1161/JAHA.115.001923
关键词
depression; epidemiology; longitudinal cohort study; marginal structural model; stroke
资金
- National Institute on Aging [NIA U01AG009740, R21 AG03438502]
- Eunice Kennedy Shriver National Institute for Child Health and Human Development at NIH [R24HD041023]
- National Institute of Neurological Disorders and Stroke at NIH [T32 NS048005]
- National Heart, Lung, and Blood Institute at NIH [1F31HL112613]
- National Institute of Mental Health at NIH [1RC4 MH092707]
- Initiative for Maximizing Student Development [5R25GM055353]
- American Heart Association [10SDG2640243, 09PRE2080078]
- National Institute of Allergy and Infectious Diseases at NIH [AI113251, AI104459]
- National Institute of Environmental Health Science [AI113251]
Background-Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. Methods and Results-Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was >= 3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (>= 65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67). Conclusions-In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.
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