Depression's impact on cardiovascular disease risk based on sex

Depression's impact on cardiovascular disease risk based on sex | Image Credit: © zinkevych - © zinkevych - stock.adobe.com.

Although both men and women with depression have an increased risk of cardiovascular disease (CVD), women have a greater risk, a new study found.¹

“Our study found that the impact of sex differences on the association between depression and cardiovascular outcomes was consistent,” said investigator Hidehiro Kaneko, MD, assistant professor at the University of Tokyo, in a press release.²

Cardiovascular disease disproportionally affects women, accounting for 35% of women's deaths annually.³ This is greater than cancer deaths, heart attacks, and stroke, even though society often associates these conditions as more commonly impacting men.

Since CVD in women remains “understudied, under-diagnosed, and under-treated,” according to a 2021 study published in The Lancet, gaps exist in the knowledge regarding women’s cardiovascular health care, impacting treatment.⁴ Some providers are not trained enough to identify symptoms of a heart attack in women.³ Some women may experience no symptoms before heart attack, and other women experience angina; pain in the neck, jaw, or throat; pain in the upper abdomen or back; nausea; vomiting; and fatigue.

Among many other conditions, depression serves as a risk factor for CVD, and according to the Anxiety & Depression Association of America, women are 2 to 3 times more likely than men to have clinical depression. Many social factors can cause depression among females—from stress related to work and family responsibilities to societal expectations.

Investigators, led by Keitaro Senoo, MD, from Kyoto Prefectural University of Medicine in Japan, conducted an observational cohort study to assess the association between depression and CVD, providing insight into potential mechanisms contributing to sex-based differences.1 The differences shed light on ways to prevent and manage CVD according to sex-specific factors.

“A better understanding will allow healthcare providers to optimize care for both men and women with depression, leading to improved CVD outcomes for these populations,” Kaneko said.²

The team leveraged data from the JMDC Claims database between 2005 and 2022—a combination of a database of health checkup and administrative claims data in Japan—identifying 4,125,720 participants who met the criteria. The study included 2,370,986 men, and the median age was 44 (36 – 52) years old.

Investigators collected data on body mass index (BMI), blood pressure, and fasting laboratory values at their initial health checkup. They wanted to assess for MI, angina pectoris, stroke, heart failure (HF), and atrial fibrillation (AF).

In the sample, depression was present in 4.2% of male participants and 4.5% of female participants.¹

Ultimately, women had a greater hazard ratio of depression for CVD than men (1.64; 95% confidence interval [CI], 1.59 – 1.70 vs. 1.39; 95% CI, 1.35 – 1.42; P < .001). Additionally, models demonstrated the hazard ratios of depression for MI, angina pectoris, stroke, HF, and AF were greater for women than men.

Investigators highlighted why depression impacts the heart health of women more than men. They explained women may face more severe and persistent symptoms of depression compared to men. Additionally, women may have a greater depression risk during critical periods of hormonal changes, including pregnancy or menopause.

Furthermore, women have a greater susceptibility to the risk factors of hypertension, diabetes, and obesity when depressed—all of which can contribute to the development of CVD. Moreover, the team suggested healthcare treatment differences between men and women, as well as differences in genetics and hormonal profiles, may increase a woman’s risk of CVD.

Investigators highlighted multiple limitations, including not being able to establish direct causality between depression and CVD events, not being able to determine the severity or duration of depressive symptoms, and not accounting for other potential confounding factors such as socioeconomic status and COVID-19.

“Healthcare professionals must recognize the important role of depression in the development of CVD and emphasize the importance of a comprehensive, patient-centered approach to its prevention and management,” Kaneko said.² “Assessing the risk of CVD in depressed patients and treating and preventing depression may lead to a decrease of CVD cases.”

References

1. Senoo, K, Kaneko, H, Ueno, K, et al. Sex Differences in the Association Between Depression and Incident Cardiovascular Disease. Journal of the American College of Cardiology. 2024.
2. Women With Depression Face Higher Cardiovascular Risk Than Men. EurekAlert! March 12, 2024. https://www.eurekalert.org/news-releases/1036966. Accessed March 11, 2024.
3. Depression & The Heart: Understanding Cardiovascular Risk Factors In Women. RTI Health Advance. February 22, 2023. https://healthcare.rti.org/insights/heart-disease-and-depression-in-women#:~:text=The%20AHA%20study%20noted%20that,more%20likely%20than%20men%20to. Accessed March 11, 2024.
4. Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet. 2021;397(10292):2385-2438. doi:10.1016/S0140-6736(21)00684-X