People with depression face an increased risk of cardiovascular disease; however, more women experience cardiovascular disease following a depression diagnosis than men, according to a new study published today in JACC: Asia. The study investigates the connection between depression and cardiovascular disease, shedding light on potential mechanisms that contribute to its sex-based differences and underscoring the importance of tailoring cardiovascular disease prevention and management strategies according to sex-specific factors.

Keitaro Senoo, MD, et al., evaluated the association between depression and subsequent cardiovascular disease events by conducting a retrospective analysis using data collected between 2005 and 2022 in the JMDC Claims Database in Japan. They identified 4,125,720 participants who met the study’s criteria. The median age was 44 (36-52) years, and 1,754,734 participants were women. Depression was defined as those clinically diagnosed before their initial health checkup.

Using standardized protocols, the study collected participant’s body mass index, blood pressure and fasting laboratory values at their initial health checkup. The primary outcome was a composite endpoint including myocardial infarction (MI), angina pectoris, stroke, heart failure (HF) and atrial fibrillation (AFib).

Researchers analyzed the statistical significance of differences in clinical characteristics between participants with and without depression. Results indicate that the hazard ratio of depression for cardiovascular disease was 1.39 in men and 1.64 in women compared with participants without depression. Models also indicate that hazard ratios of depression for MI, angina pectoris, stroke, HF and AFib were higher for women than for men.

Study authors highlight an important discussion regarding the potential mechanisms that may contribute to why depression impacts women’s heart health more than men's. One explanation is that women may experience more severe and persistent symptoms of depression compared to men, and they may be more likely to have depression during critical periods of hormonal changes, such as pregnancy or menopause.

Other mechanisms include women’s greater susceptibility to traditional risk factors when depressed, such as hypertension, diabetes and obesity, which may contribute to the development of cardiovascular disease. Differences in health care utilization and treatment between men and women and sex-specific differences in biological factors, such as genetics and hormonal profiles, may also increase women’s cardiovascular disease risk.

“Our study found that the impact of sex differences on the association between depression and cardiovascular outcomes was consistent,” said Hidehiro Kaneko, MD, an author of the study. “Health care professionals must recognize the important role of depression in the development of cardiovascular disease and emphasize the importance of a comprehensive, patient-centered approach to its prevention and management. Assessing the risk of cardiovascular disease in depressed patients and treating and preventing depression may lead to a decrease of cardiovascular disease cases.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Diabetes Mellitus, Menopause, Hypertension, Heart Failure, Obesity, Stroke, Myocardial Infarction, Atrial Fibrillation, Pregnancy, ACC International