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Can Depression Raise Stroke Risk?

PHILADELPHIA — Depressive symptoms were tied to an increased risk of ischemic stroke, a prospective cohort study of largely Hispanic older adults found.

Over 14 years of follow-up, older adults who had elevated depressive symptoms were 75% more likely to develop incident stroke than people who didn’t show signs of depression, reported Marialaura Simonetto, MD, of the University of Miami, Miller School of Medicine, and colleagues, in an early-release abstract from the American Academy of Neurology meeting to be held here in May.

“Depression is common and often goes untreated, so these results could hold great promise as we learn more about how depression may affect people’s risk for stroke and other cardiovascular problems and ultimately develop ways to prevent these problems,” Simonetto said in a statement.

“If people with depression are at elevated risk of stroke, early detection and treatment will be even more important,” he added.

The findings come on the heels of an Australian study that showed psychological distress, including anxiety and depression, had a strong dose-dependent association with stroke and myocardial infarction that persisted after adjusting for a wide range of confounders.

While mental health problems like depression have been tied to stroke and cardiovascular problems in other research, most studies have looked at mortality, not incidence. The effect of depression on incident stroke risk is underexplored, especially among Latinos and African Americans, Simonetto and co-authors noted.

For this analysis, the researchers studied participants from the Northern Manhattan Study (NOMAS) MRI sub-study, a mostly Hispanic cohort comprised of older adults who were clinically stroke-free at baseline. The study examined data from about 1,104 people with a mean age of 70 years; 61% were women and 69% were Hispanic.

The researchers measured depressive symptoms with the Center for Epidemiological Studies–Depression Scale (CES-D), a survey that asks participants about behaviors and feelings in the past week. Scores on the CES-D range from 0-60, and a score ≥16 was considered elevated. At baseline, 198 participants (18%) had elevated depressive symptoms.

Over 14 years of follow-up, 101 participants had incident strokes (cumulative incidence 14%); 87 were ischemic strokes (cumulative incidence 13%). The risk of ischemic stroke was significantly increased among people with elevated depressive symptoms (HR 1.75, 95% CI 1.06–2.88), after adjusting for age, sex, race and ethnicity, years of education, smoking, physical activity, alcohol consumption, diabetes, and hypertension.

Every five-point increase in CES-D score was tied to a 12% greater risk of ischemic stroke (HR 1.12, 95% CI 1.01–1.25), the researchers reported.

How depression and stroke are connected is unclear, Simonetto said. “The mechanisms behind this association are complex,” she told MedPage Today.

“Depression might be a risk factor for ischemic stroke through complex brain mechanisms that are not yet fully understood, or it might be that people with depression may encounter obstacles accessing healthcare,” Simonetto suggested.

The findings demonstrate the need for future research, she noted. While the study supports a link between elevated depressive symptoms and risk of incident ischemic stroke, it was observational and does not show causality, she added.

The study was supported by the National Institute of Neurological Disorders and Stroke as part of the Northern Manhattan Study, an ongoing collaborative research project between the University of Miami and Columbia University in New York.