ORLANDO — The higher incidence of depression after a myocardial infarction in women, compared with men, contributes to the worse outcomes that women face, according to data from a study with more than 2,400 patients.
“The clinical implication is that it's important to identify and treat symptoms of depression at the time of hospitalization for myocardial infarction,” Dr. Susmita Parashar said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.
These steps are reasonable, even though studies are still needed to test whether treating depression after an MI improves the cardiovascular outcomes of both women and men, said Dr. Parashar, a physician and epidemiologist at Emory University, Atlanta.
She and her associates used data collected on 2,411 acute MI patients in the Prospective Registry Evaluating Myocardial Infarction Events and Recovery (PREMIER) study. Data were collected at 17 U.S. centers between January 2003 and June 2004. Patients with a documented MI were assessed for depression during their initial hospitalization and at follow-up with the Patients Health Questionnaire (PHQ).
During initial hospitalization, 29% of 752 women in the registry were diagnosed with depression by the PHQ, compared with 19% of 1,531 men, a significant difference. (Data on depression diagnosis were not available for all patients in the registry.)
In an analysis that adjusted for age at baseline, women were 18% more likely than men to need rehospitalization during 12 months of follow-up, a significant difference. In a second analysis that adjusted for age, race, and clinical factors at baseline including diabetes, hypertension, lung disease, and smoking history, women were 20% more likely than men to be hospitalized during follow-up.
But when the analysis adjusted for baseline differences in the PHQ score, the resulting 14% difference in hospitalization rate between men and women was no longer statistically significant, which suggested that baseline depression scores had played a role in the subsequent rates of hospitalization.
A similar pattern was seen for the role of depression in the incidence of angina during follow-up. (See box.) But no analysis found a significant difference in the mortality of men and women during follow-up.
Other findings from the registry showed women were more likely than men to be treated for depression, but adjusting for the use of antidepression treatment had no impact on the gender difference in rates of rehospitalization or angina. Depression after an MI also was about fourfold more common in women younger than 60 years, compared with older women, Dr. Parashar said.
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