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Year : 2022  |  Volume : 6  |  Issue : 4  |  Page : 254-261

Depression symptom patterns as predictors of metabolic syndrome and cardiac events in symptomatic women with suspected myocardial ischemia: The women's ischemia syndrome evaluation (WISE and WISE-CVD) projects

1 Department of Clinical Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego, California, USA
2 Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
3 Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama, USA
4 Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
5 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
6 Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
7 Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
8 Psychology Service, VA San Diego Healthcare System; Department of Psychiatry, University of California, San Diego, California, USA

Correspondence Address:
Dr. Thomas Rutledge
Psychology Service 116B, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/hm.hm_35_22

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Background: Ischemic heart disease (IHD) risk in women includes biomedical, behavioral, and psychosocial contributors. The purpose of this study was to build upon previous research suggesting that in women, somatic symptoms (SS) of depression may be important to the development of IHD risk factors and major adverse cardiovascular events (MACE). Based on previous findings, we hypothesized that: (1) SS would be associated with robust biomedical predictors of heart disease and functional capacity, while cognitive symptoms (CS) of depression would not, and (2) SS would independently predict adverse health outcomes while CS would not. Methods: We examined the relationships between symptoms of depression (SS/CS), metabolic syndrome (MetS), inflammatory markers (IM), coronary artery disease (CAD) severity, and functional capacity in two independent cohorts of women with suspected IHD. In the Women's Ischemia Syndrome Evaluation (WISE), we also examined these variables as predictors of all-cause mortality (ACM) + MACE over a median 9.3-year follow-up. The WISE sample included 641 women with suspected ischemia with or without obstructive CAD. The WISE-Coronary Vascular Dysfunction (WISE-CVD) sample consisted of 359 women with suspected ischemia and no obstructive CAD. All study measures were collected uniformly at baseline. Depressive symptoms were measured via the Beck Depression Inventory. MetS was assessed according to Adult Treatment Panel III (ATP-III) criteria. Results: In both studies, SS was associated with MetS (Cohen's d = 0.18, 0.26, P < 0.05, respectively), while CS was not. Within WISE, using Cox Proportional Hazard Regression, SS (Hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.01–1.15; HR = 1.07, 95% CI = 1.00–1.13) and MetS (HR = 1.89, 95% CI = 1.16–3.08; HR = 1.74, 95% CI=1.07–2.84) were independent predictors of ACM + MACE after controlling for demographics, IM, and CAD severity, while CS was not. Conclusions: In two independent samples of women undergoing coronary angiography due to suspected ischemia, SS but not CS of depression were associated with MetS, and both SS and MetS independently predicted ACM and MACE. These results add to previous studies suggesting that SS of depression may warrant specific attention in women with elevated cardiovascular disease (CVD) risk. Future research evaluating the biobehavioral basis of the relationship between depression, MetS, and CVD is needed.

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