The female population is more vulnerable to depression, as according to the World Health Organization (WHO), this mental disorder “is approximately 50% more common among women than among men.” Now, a study published in JACC: Asia reveals that people with depression have a higher risk of developing cardiovascular diseases (CVD), and that women are also more susceptible to this condition after a diagnosis of depression compared to men.
Depression is considered the third leading cause of morbidity worldwide and is closely linked to an increased risk of cardiovascular events such as heart attacks, angina, strokes and cardiovascular mortality. Although women with depression face a relatively higher risk of suffering negative consequences for heart health compared to men, there is still debate about how depression differentially affects heart health in both sexes and the mechanisms underlying these differences.
The new research, conducted by experts at the University of Tokyo, takes an in-depth look at how depression is related to cardiovascular disease, highlighting gender-based differences and the need to tailor CVD prevention and management strategies to take these specific factors into account.
Dr Hidehiro Kaneko, assistant professor at the University of Tokyo and senior author of the study, has highlighted the importance of identifying sex-specific factors in the adverse effects of depression on cardiovascular outcomes. This could facilitate the development of prevention and treatment strategies targeting the particular CVD risks faced by patients with depression, thereby improving outcomes in both sexes.
Factors influencing increased risk of CVD in depressed women
Researchers assessed the association between depression and subsequent cardiovascular events using an observational cohort study using the JMDC claims database from 2005 to 2022. They identified 4,125,720 participants who met the study criteria. The median age was 44 (36-52) years and 2,370,986 participants were men. Depression was defined as being clinically diagnosed before their initial medical checkup.
Factors such as body mass index (BMI), blood pressure and fasting laboratory values were assessed, focusing on outcomes such as heart attacks, angina, stroke, heart failure and atrial fibrillation. The researchers analysed the statistical significance of differences in clinical characteristics between participants with and without depression.
Women may experience more severe and persistent symptoms of depression and are more likely to suffer from depression during critical periods of hormonal changes, such as pregnancy or menopause.
The results indicate that the hazard ratio for depression due to CVD was 1.39 in men and 1.64 in women compared with participants without depression. The models also indicate that the hazard ratios for depression due to myocardial infarction, angina, stroke, heart failure, and atrial fibrillation were higher in women than in men.
The authors suggest that women may experience more severe and persistent depressive symptoms and are more likely to suffer from depression during critical periods of hormonal change, such as pregnancy or menopause. In addition, factors such as hypertension, diabetes and obesity, which are more prevalent in depressed women, together with differences in health care utilization and sex-specific biological factors, could explain the increased risk of CVD.
In their article, as reported in the American College of Cardiology, the researchers explain that their study “provides evidence of a significant association between depression and subsequent cardiovascular events in both men and women, with a more pronounced association observed in women. These findings highlight the importance of addressing depression and tailoring prevention and management strategies according to sex-specific factors.”
The authors have acknowledged limitations, such as the inability to establish direct causality between depression and cardiovascular events and the influence of potential confounding factors not considered, including socioeconomic status and the COVID-19 pandemic.
