Abstract
Although a relationship between depression and cardiovascular events has been suggested, past study results regarding the risk of stroke in relation to depression by subgroups are ambiguous. The aim of this study was to investigate the influence of depressive symptoms on risk of incident ischemic stroke in elderly according to age and sex. This prospective cohort study followed up 3852 subjects older than 55 years. Baseline depressive symptoms were defined by a score ≥5 on the Geriatric Depression Scale or antidepressant intake. The outcome measure was incident ischemic stroke within 6 years of follow-up. Multivariate Cox-proportional hazard models as well as cumulative survival analyses were computed. A total of 156 ischemic strokes occurred during the study period (24 strokes in the age-group<65 years and 132 strokes in the age-group≥65 years). The distribution of strokes in sex-subgroups was 4.5% in men and 3.7% in women. The multivariate analysis showed an elevated stroke risk (Hazard Ratio (HR): 2.84, 95% CI 1.11–7.29, p = 0.030) in subjects from 55 to 64 years with depressive symptoms at baseline but not in subjects older than 65 years. In the multivariate analysis according to sex the risk was increased in women (HR: 1.62, 95% CI 1.02–2.57, P = 0.043) but not in men. The Cox-regression model for interaction showed a significant interaction between age and sex (HR: 3.24, 95% CI 1.21–8.69, P = 0.020). This study corroborates that depressive symptoms pose an important risk for ischemic stroke, which is particularly remarkable in women and patients younger than 65 years.
Highlights
Stroke prevention requires the treatment of modifiable ‘‘classical risk factors’’ such as coronary heart disease (CHD), hypertension, cigarette smoking, diabetes mellitus, hyperlipidemia, obesity, atrial fibrillation, and physical inactivity as well as recently suggested or less well studied risk factors such as metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, migraine, hyperhomocysteinemia, elevated lipoprotein(a), hypercoagulability, inflammation, and infection [1]
We investigated an association between depression and incident ischemic stroke among elderly patients with adjustment for the established risk factors
The mean baseline Geriatric depression scale (GDS) scores differed between age groups and were 2.21 for subjects aged 55–64 years versus 2.61 for $65 years
Summary
Stroke prevention requires the treatment of modifiable ‘‘classical risk factors’’ such as coronary heart disease (CHD), hypertension, cigarette smoking, diabetes mellitus, hyperlipidemia, obesity, atrial fibrillation, and physical inactivity as well as recently suggested or less well studied risk factors such as metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, migraine, hyperhomocysteinemia, elevated lipoprotein(a), hypercoagulability, inflammation, and infection [1]. A link between depression and the incidence of stroke has been strengthened by two recent metaanalyses [2,10], but findings in elderly subgroups by age and sex are still partly ambiguous [11] and separate risk estimations for them are rarely available. Whereas a recent large population-based study (n = 80 574 women aged 54 to 79 years, the Nurses’ Health Study) showed an increased stroke risk in women with a previous diagnosis of depression [12], other studies found no clear evidence of depression being a significant risk factor for cerebrovascular diseases [13,14] or an increased risk only for patients younger than 65 years [11]. Sex differences in the clinical course and incidence of depression have been repeatedly shown [15,16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
