• Doyle M Cummings, Lesley D Lutes, J Lane Wilson, Marissa Carraway, Monika M Safford, Andrea Cherrington, D Leann Long, April P Carson, Ya Yuan, Virginia J Howard, and George Howard.
• Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA. cummingsd@ecu.edu.
• J Gen Intern Med. 2022 Dec 1; 37 (16): 408040874080-4087.

BackgroundBaseline depressive symptoms are associated with subsequent adverse cardiovascular (CV) events in subjects with and without diabetes but the impact of persistent symptoms vs. improvement remains controversial.ObjectiveExamine long-term changes in depressive symptoms in individuals with and without diabetes and the associated risk for adverse CV events.DesignREGARDS is a prospective cohort study of CV risk factors in 30,000 participants aged 45 years and older.ParticipantsN = 16,368 (16.5% with diabetes mellitus) who remained in the cohort an average of 11.1 years later and who had complete data.Main MeasuresDepressive symptoms were measured using the 4-item Centers for Epidemiologic Study of Depression (CES-D) questionnaire at baseline and again at a mean follow-up of 5.07 (SD = 1.66) years. Adjudicated incident stroke, coronary heart disease (CHD), CV mortality, and a composite outcome were assessed in a subsequent follow-up period of 6.1 (SD = 2.6) years.MethodsThe association of changes in depressive symptoms (CES-D scores) across 5 years with incident CV events was assessed using Cox proportional hazards modeling.Key ResultsCompared to participants with no depressive symptoms at either time point, participants without diabetes but with persistently elevated depressive symptoms at both baseline and follow-up demonstrated a significantly increased risk of incident stroke (HR (95% CI) = 1.84 (1.03, 3.30)), a pattern which was substantially more prevalent in blacks (HR (95% CI) = 2.64 (1.48, 4.72)) compared to whites (HR (95% CI) = 1.06 (0.50, 2.25)) and in those not taking anti-depressants (HR (95% CI) = 2.01 (1.21, 3.35)) in fully adjusted models.ConclusionsThe persistence of depressive symptoms across 5 years of follow-up in participants without diabetes identifies individuals at increased risk for incident stroke. This was particularly evident in black participants and among those not taking anti-depressants.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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