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Depressive symptoms, antidepressants and disability and future coronary heart disease and stroke events in older adults: the Three City Study

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Abstract

To investigate the association between baseline depressive symptoms and first fatal and non fatal coronary heart disease (CHD) and stroke in older adults, taking antidepressants and disability into account. In the Three City Study, a community-based prospective multicentric observational study cohort, 7,308 non-institutionalized men and women aged ≥65 years with no reported history of CHD, stroke or dementia, completed the 20-item Center for Epidemiologic Studies Depression Scale (CESD) questionnaire. First CHD and stroke events during follow-up were adjudicated by an independent expert committee. Hazard ratios (HRs) were estimated by Cox proportional hazard model. After a median follow-up of 5.3 years, 338 subjects had suffered a first non-fatal CHD or stroke event, and 82 had died from a CHD or stroke. After adjustment for study center, baseline socio-demographic characteristics, and conventional risk factors, depressive symptoms (CESD ≥ 16) were associated with fatal events only: fatal CHD plus stroke (HR = 2.50; 95 % CI 1.57–3.97), fatal CHD alone (n = 57; HR = 2.21 ; 95 %CI 1.27–3.87), and fatal stroke alone (n = 25; HR = 3.27; 95 % CI 1.42–7.52). These associations were even stronger in depressed subjects receiving antidepressants (HR = 4.17; 95 % CI 1.84–9.46) and in depressed subjects with impaired Instrumental Activities of Daily Living (HR = 8.93; 95 % CI 4.60–17.34). By contrast, there was no significant association with non fatal events (HR for non-fatal CHD or stroke = 0.94; 95 % CI 0.66–1.33). In non-institutionalized elderly subjects without overt CHD, stroke or dementia, depressive symptoms were selectively and robustly associated with first fatal CHD or stroke events.

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Acknowledgments

The Three City Study was conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen–Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale financed the preparation and initiation of the study. The Three City Study was also supported by the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, the Direction Générale de la Santé, the MGEN, the Institut de la Longévité, the Regional Councils of Aquitaine and Bourgogne, the Fondation de France and the Ministry of Research–INSERM Program “Cohortes et collections de données biologiques.” The funding sources had no role in the study design; the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Conflict of interest

Dr. Tzourio serves on scientific advisory boards for Merck Sharp & Dohme and the Fondation Plan Alzheimer, serves on the editorial boards of Neuroepidemiology and the Journal of Hypertension, and receives research support from the Agence Nationale de la Recherche and Fondation Plan Alzheimer. Dr. Empana has received consultancy honoraria from Lundbeck and speaker honoraria from Pfizer.

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Authors and Affiliations

  1. INSERM U970, Paris Cardiovascular Research Centre, Paris Descartes University, Sorbonne Paris Cité, UMR-S970, 75015, Paris, France

    Renaud Péquignot, Marie-Cécile Perier & Jean-Philippe Empana

  2. Service de Médecine et Réadaptation, Hôpitaux de Saint-Maurice, 14 rue du Val d’Osne, 94415, Saint-Maurice CEDEX, France

    Renaud Péquignot

  3. INSERM U708, 75651, Bordeaux, France

    Christophe Tzourio

  4. INSERM U897, 33076, Bordeaux, France

    Karine Péres

  5. INSERM U888, Montpellier 1 University, 34093, Montpellier, France

    Marie-Laure Ancellin

  6. Paris-Sud University, 94807, Villejuif, France

    Pierre Ducimetière

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  1. Renaud Péquignot
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  2. Christophe Tzourio
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  3. Karine Péres
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  4. Marie-Laure Ancellin
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  5. Marie-Cécile Perier
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  6. Pierre Ducimetière
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  7. Jean-Philippe Empana
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Correspondence to Renaud Péquignot or Jean-Philippe Empana.

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Péquignot, R., Tzourio, C., Péres, K. et al. Depressive symptoms, antidepressants and disability and future coronary heart disease and stroke events in older adults: the Three City Study. Eur J Epidemiol 28, 249–256 (2013). https://doi.org/10.1007/s10654-013-9765-3

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  • DOI: https://doi.org/10.1007/s10654-013-9765-3

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