An Emory University study, published today in the Journal of the American Heart Association, shows women age 55 and younger are twice as likely to suffer a heart attack, die or require artery-opening procedures if they are moderately or severely depressed.

The research, funded by the National Institutes of Health and the Emory Heart & Vascular Center, also showed that women in this age group are at greater risk than men and older women to suffer from depression — possibly a "hidden" risk factor that helps explain why more women die after a heart attack.

"Women in this age group are also more likely to have depression, so this may be one of the ‘hidden’ risk factors that can help explain why women die at a disproportionately higher rate than men after a heart attack," says study author Amit J. Shah, MD, assistant professor of epidemiology, Rollins School of Public Health (RSPH), and assistant professor of medicine (cardiology), Emory University School of Medicine (SOM). 

Investigators assessed symptoms of depression in 3,237 people with known or suspected heart disease (34 percent women, average age 62.5 years) scheduled for coronary angiography, an X-ray that diagnoses disease in the arteries that supply blood to the heart. After nearly three years of follow-up, they found:

• In women 55 and younger, after adjusting for other heart disease risk factors, each 1-point increase in symptoms of depression was associated with a 7 percent increase in the presence of heart disease.
• In men and older women, symptoms of depression didn’t predict the presence of heart disease.
• Women 55 and younger were 2.2 times as likely to suffer a heart attack, die of heart disease or require an artery-opening procedure during the follow-up period if they had moderate or severe depression.
• Women 55 and younger were 2.5 times as likely to die from any cause during the follow-up period if they had moderate or severe depression.

"All people, and especially younger women, need to take depression very seriously," says Shah. "Depression itself is a reason to take action, but knowing that it is associated with an increased risk of heart disease and death should motivate people to seek help."

According to Shah, providers should ask more questions and be aware that young women are especially vulnerable to depression, and that it may increase the risk to their heart.

"Although the risks and benefits of routine screening for depression are still unclear, our study suggests that young women may benefit from special consideration," says senior study author Viola Vaccarino, MD, PhD, professor and Wilton Looney Chair of Epidemiology at RSPH and professor of medicine, Emory University SOM. "Unfortunately, this group has largely been understudied before."

The American Heart Association recently issued a statement recommending that depression be formally considered as a risk factor, like diabetes or hypertension, for increased heart disease risk.

"Our data are in accordance with this recommendation," adds Vaccarino, "but suggest that young/middle aged women may be especially vulnerable to depression as a risk factor."

The research group is examining whether women have more cardiovascular changes than men in response to short-term mental stress, such as giving a public speech.

Co-authors are Nima Ghasemzadeh, MD; Elisa Zaragoza-Macias, MD; Riyaz Patel, MD; Danny J. Eapen, MD; Ian J. Neeland, MD; Pratik M. Pimple, MPH; A. Maziar Zafari, MD, PhD; and Arshed A. Quyyumi, MD.