Women With Depression Face a Higher Risk of Heart Disease Than Men
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Researchers found that women with a previous diagnosis of depression were more likely to have a heart attack, stroke, heart failure, chest pain, and atrial fibrillation compared with men who have a history of depression.
“A better understanding will allow healthcare providers to optimize care for both men and women with depression, leading to improved [heart disease] outcomes for these populations,” said Dr. Kaneko.
“The association of depression and cardiovascular disease for both men and women is something we’ve known for decades, and this study is exploring a newer aspect of that, which is how that risk may be affected by sex,” says Sharonne Hayes, MD, a cardiologist at Mayo Clinic in Rochester, Minnesota, and expert in the link between heart disease and depression who was not involved in this research.
However, there are some key differences in the population included in this study compared with the U.S. population, which could affect whether the findings could be generalized, says Dr. Hayes.
The Link Between Depression and Heart Disease
Depression seems to increase the risk of developing heart disease, and having heart disease seems to increase the risk of developing depression — it’s a bidirectional relationship, says Roy Charles Ziegelstein, MD, a professor of medicine at Johns Hopkins Medicine in Baltimore and researcher in depression among people with heart disease.
“Once you have heart disease, depression actually makes the outcome from the heart disease worse. So, for example, if you’ve had a heart attack and you’re depressed, your chances of not doing well are greater compared with individuals who’ve had similar heart event but who don’t have depression. And as this study shows, that relationship seems to be bidirectional: Having a diagnosis of depression increases the risk of developing heart disease,” says Dr. Ziegelstein, who was not involved in this study.
History of Depression Appears to Have a Greater Effect on Women’s Heart Health Compared With Men
The observational cohort study used a Japanese insurance claims database between 2005 and 2022 and identified over four million participants who met the study’s criteria. The population, made up of employees and their family members, had a median age of 44 (36 to 52) years old, and about 57 percent of participants were men. Depression was defined as those clinically diagnosed before their initial health checkup.
The study collected each participant’s body mass index (BMI), blood pressure, and fasting laboratory values at their initial health checkup. The primary outcome was a composite endpoint including heart attack, chest pain, stroke, heart failure, and atrial fibrillation.
After analyzing the statistical significance of differences in the different heart events between participants with and without depression, researchers found that having a previous diagnosis of depression raised the risk for heart disease by 39 percent in men and 64 percent in women.
Investigators also found that the risk for each type of heart event was higher in women with depression compared with men with depression.
Why Does Depression Impact Women’s Heart Health More Than Men’s?
According to the study authors, one possible explanation for the differences in heart events is that women may experience more severe depression compared with men, says Hayes. “But because that information isn’t available in the claims data, we can’t know,” she says.
Another theory behind those differences are the hormonal transitions that affect women but not men — things like pregnancy, postpartum depression, perimenopause, and menopause. “Obviously, sex hormones and fluctuations throughout life are quite different between men and women,” says Hayes.
But there are also behavior differences that don’t have anything to do with sex hormones, she points out. “For example, globally, women are less physically active than men. Women, especially when they are younger, go to the doctor more than men,” says Hayes.
“We also know that those conventional cardiovascular risk factors affect men and women differently. We know that hypertension in women increases their risk of stroke considerably more than hypertension in men. Smoking also increases risk of cardiovascular disease in women more compared with men, whereas an elevated LDL cholesterol … probably has a higher impact on men,” she says.
Interestingly, the prevalence of depression was nearly identical for men and women in this study: 4.2 percent of men and 4.5 percent of women, Hayes points out. “In the United States, women are nearly twice as likely as men to be diagnosed with depression, so that’s a big difference,” says Hayes.
The Bottom Line: Women Should Pay Attention to Their Risk Factors for Heart Disease, Including Current or Past Depression
“If you’re biologically prone to depression, it’s not like you can snap your fingers or wave a magic wand to ensure you won’t have a recurrent episode of depression. You also can’t change the past, for example, if you had an episode of postpartum depression when you were 30, and now you’re 50. But it’s a risk factor you need to be aware of,” says Hayes.
Although it’s not a traditional risk factor, women may want to view past depression just as they would a family history of heart disease or high cholesterol, she suggests. “Because of that, those women should ‘double down’ on modifiable risk factors: things like exercising more, following a heart-healthy eating pattern, not smoking, and making sure they know their numbers. If your doctor has recommended lifestyle changes or medications for lowering your cholesterol or blood pressure, take advantage of those so that you can lower your risk of stroke, heart attack, atrial fibrillation,” says Hayes.
Women also need to pay attention to symptoms of heart attack, says Ziegelstein. “If they are developing any sort of discomfort in their chest, breathlessness, discomfort in their upper back shoulders, especially while they’re exercising, they need to seek medical attention. If it doesn’t go away after a few minutes, even when they’re at rest, they need to call for emergency medical services,” he says.
Finally, women who have symptoms of depression — such as sadness or no longer feeling pleasure from things that you enjoyed in the past — should talk to their doctor and get the treatment they need, says Ziegelstein.
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