Somatic Versus Cognitive Depressive Symptoms as Predictors of Coronary Artery Disease among Women with Suspected Ischemia: The Women’s Ischemia Syndrome Evaluation

• Type of Material: Article
• Authors: Ashley S. Emami, VA San Diego Healthcare System; C. Noel Bairey Merz, Cedars-Sinai Smidt Heart Institute; Jo-Ann Eastwood, University of California Los Angeles; Carl J. Pepine, University of Florida; Eileen M. Handberg, University of Florida; Vera Bittner, University of Alabama; Puja Mehta, Emory University; David S. Krantz, Uniformed Services University; Viola Vaccarino, Emory University; Wafia Eteiba, University of Pittsburgh; Carol E. Cornell, University of Arkansas; Thomas Rutledge, VA San Diego Healthcare System
• Language: English
• Date: 2021-11-30
• Publisher: Wolters Kluwer
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: This is an open access journal
• License: Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4103/hm.hm_34_21
• Title of Journal or Parent Work: Heart and Mind
• Volume: 5
• Issue: 4
• Start Page: 112
• End Page: 118
• Grant/Funding Information: This work was supported by contracts from the National Heart, Lung, and Blood Institutes, nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U01 64829, U01 HL649141, U01 HL649241, T32 HL69751, K23HL105787, K23HL127262, K23HL125941, 1R03 AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences Grant UL1TR000124 and UL1TR000064, and the Edythe L. Broad Women’s Heart Research Fellowship, the Constance Austin Women’s Heart Health Fellowship, both at Cedars-Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, the Linda Joy Pollin Women’s Heart Health Program, and the Erika Glazer Women’s Heart Health Project. Dr. Pepine was also supported by National Institute of Health grants HL33610, HL56921; UM1 HL087366; the Gatorade Trust and the McJunkin Family Foundation through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692.
• Keywords: women; coronary artery disease; ischemia; Beck Depression Inventory; depression
• Research Categories: Psychology, Behavioral; Psychology, Clinical

Abstract

Background: Depression is an established predictor of coronary artery disease (CAD) progression and mortality. “Somatic” symptoms of depression such as fatigue and sleep impairment overlap with symptoms of CAD and independently predict CAD events. Differentiating between “somatic” and “cognitive” depressive symptoms in at-risk patients may improve our understanding of the relationship between depression and CAD. Methods: The study utilized data from the Women’s Ischemia Syndrome Evaluation. Participants (N = 641; mean age = 58.0 [11.4] years) were enrolled to evaluate chest pain or suspected myocardial ischemia. They completed a battery of symptom and psychological questionnaires (including the Beck Depression Inventory [BDI]) at baseline, along with quantitative coronary angiography and other CAD diagnostic procedures. The BDI provided scores for total depression and for cognitive and somatic depressive symptom subscales. Results: Two hundred and fourteen (33.4%) women met criteria for obstructive CAD. Logistic regression models were used to examine relationships between depression symptoms and obstructive CAD. Neither BDI total scores (odds ratio [OR] =1.02, 95% confidence interval [CI], 0.99–1.05, P = 0.053) nor BDI cognitive scores (OR = 1.02, 95% CI, 1.00–1.04, P = 0.15) predicted CAD status. BDI somatic symptom scores, however, significantly predicted CAD status and remained statistically significant after controlling for age, race, and education (OR = 1.06, 95% CI, 1.01–1.12, P = 0.02). Conclusion: Among women with suspected myocardial ischemia, somatic but not cognitive depressive symptoms predicted an increased risk of obstructive CAD determined by coronary angiography. Consistent with prior reports, these results suggest a focus on somatic rather than cognitive depressive symptoms could offer additional diagnostic information.