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Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization

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Abstract

Background

For patients with peripheral arterial disease (PAD), depression is associated with worse patency and recurrent symptoms in the treated leg, but its association with death or cardiovascular events in other vascular beds is unknown.

Objective

To assess the association between depression and mortality or cardiovascular events outside the affected leg after PAD revascularization.

Design

Retrospective cohort study.

Subjects

Two hundred fifty-seven consecutive patients undergoing lower extremity revascularization for symptomatic PAD at a single institution between January 2000 and May 2005 were included in this study. By protocol, patients were previously screened for depression and diagnosed by the primary care provider.

Measurements

The outcomes evaluated included a composite of death or major adverse cardiovascular events (MACE; coronary heart disease, contralateral PAD, or cerebrovascular event) as well as major outcome categories of death, coronary heart disease, contralateral PAD, or cerebrovascular events.

Results

At revascularization, 35.0% patients had been diagnosed with depression. Those with depression were significantly younger and more likely to use tobacco. By life-table analysis, patients with depression had significantly increased risk for death/MACE, coronary heart disease, and contralateral PAD events, but not cerebrovascular events or death. By multivariate analysis, patients with depression were at significantly increased risk for death/MACE (hazard ratio [HR] = 2.05; p < .0001), contralateral PAD (HR = 2.20; p = .009), and coronary heart disease events (HR = 2.31; p = .005) but not cerebrovascular events or death.

Conclusions

Depression is common among patients undergoing revascularization for symptomatic PAD. After intervention, patients with depression are at significantly increased risk for coronary heart disease events and progression of contralateral PAD. Prospective analysis is required to confirm these results.

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Acknowledgements

This work was conducted at, and supported by, the VA Western New York Healthcare System, Buffalo, NY, USA. Doctor Cherr is supported by a grant from the Dennis W. Jahnigen Career Development Scholars Awards Program, which is administered by the American Geriatrics Society through a program funded by The John A. Hartford Foundation of New York City and The Atlantic Philanthropies.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA

    Gregory S. Cherr MD, Jiping Wang MD PhD & Hasan H. Dosluoglu MD

  2. Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY, USA

    Gregory S. Cherr MD

  3. Department of Biostatistics, State University of New York at Buffalo, Buffalo, NY, USA

    Jiping Wang MD PhD

  4. Western New York Veteran’s Administration Hospital, Buffalo, NY, USA

    Gregory S. Cherr MD & Hasan H. Dosluoglu MD

  5. Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV, USA

    Pamela M. Zimmerman MD

Authors
  1. Gregory S. Cherr MD
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  2. Pamela M. Zimmerman MD
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  3. Jiping Wang MD PhD
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  4. Hasan H. Dosluoglu MD
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Corresponding author

Correspondence to Gregory S. Cherr MD.

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Cherr, G.S., Zimmerman, P.M., Wang, J. et al. Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization. J GEN INTERN MED 23, 629–634 (2008). https://doi.org/10.1007/s11606-008-0560-x

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  • DOI: https://doi.org/10.1007/s11606-008-0560-x

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