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Somatic symptoms more predictive of CV risk than cognitive depressive symptoms
9 September 2010
MedWire News:Somatic symptoms of depression are more strongly associated with cardiovascular (CV) events than are cognitive symptoms of depression in stable coronary heart disease (CHD) patients, a US study suggests.
“Our present findings provide further support for the conceptualization of depression as a heterogeneous syndrome in which some aspects may be more strongly related to CV prognosis than others,” state Petra Hoen (University Medical Center Groningen, The Netherlands) and colleagues.
To investigate the effect of different depressive symptoms on CV prognosis, the team distributed Patient Health Questionnaires (PHQ) to 1019 stable CHD patients.
In the PHQ, all patients indicated the baseline presence and severity of nine depressive somatic (change in appetite, insomnia, psychomotor agitation or retardation, and fatigue) and cognitive (low mood, apathy, worthlessness, concentration problems, and suicidal ideation) symptoms.
Over the following 6 years, the researchers monitored the development of new CV events, defined as myocardial infarction, stroke, transient ischemic attack, or congestive heart failure, among the patients.
Writing in the Journal of the American College of Cardiology, Hoen et al report that after adjustment for demographic characteristics, cardiac risk factors such as hypertension, and cardiac medication, each somatic symptom was associated with a 14% increase in risk for CV events compared with no somatic symptoms of depression (p=0.002).
When symptoms were considered individually, the team found that the three commonest somatic symptoms fatigue, insomnia, and appetite changes had the greatest independent associations with CV events, being associated with 1.43-, 1.46-, and 1.26-fold increases in CV events risk, respectively (p=0.01, p=0.005, and p=0.05, respectively).
However, patients with cognitive symptoms had a nonsignificant 8% increase in CV events risk per symptom compared with those with no cognitive symptoms of depression.
Similarly, when the presence of each cognitive symptom was considered individually, the CV event risk of patients with any cognitive symptoms did not significantly differ from that of patients with no cognitive symptoms of depression.
Hoen and colleagues conclude: “These results may be of importance for identifying depressed patients who are at highest risk for developing CV events and for identifying potential therapies to improve CV outcomes in patients with CHD.”
They add: “The results of this study indicate the need for future research directed at the identification of the underlying pathophysiological processes by which somatic depressive symptoms contribute to prognosis in patients with CHD.”
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