Depressive symptoms foretell HFpEF risk in late life

A recent study has shown that depression predicts the risk of developing heart failure (HF) with preserved ejection fraction (HFpEF) in late life, and the greater the symptoms, the higher the risk.

The study looked at 6,025 individuals (mean age 75.3 years, 59 percent women, 20 percent Black) who participated in the ARIC (Atherosclerosis Risk in Communities) study, all of whom underwent echocardiography and completed the Center for Epidemiologic Studies Depression Scale (CES‐D) questionnaire.

There were 5,086 participants (mean age 75.3 years, 59 percent women) who were free of HF. Their median CES‐D score was 2, and 287 (6 percent) participants had severe depressive symptoms (CES‐D score of ≥9). Participants with higher CES‐D score were more likely to be female, White, have higher body mass index, and a higher prevalence of cardiovascular comorbidities, among others.

Compared with HF‐free participants, those with prevalent HFpEF but not HF with reduced ejection fraction (HFrEF) were more likely to have depressive symptoms (p<0.001 and p=0.59, respectively). Among HF‐free participants, CES‐D score had a null association with cardiac structure and function. 

Over 5.5 years of follow‐up, higher CES-D score correlated with a heightened risk of incident HFpEF (hazard ratio [HR], 1.06, 95 percent confidence interval [CI], 1.04–1.12; p=0.02), but not HFrEF (HR, 1.02, 95 percent CI, 0.96–1.08; p=0.54). The association was not modified by echocardiographic measures, N‐terminal pro‐B‐type natriuretic peptide, troponin, and high‐sensitivity C‐reactive protein.

More studies are needed to understand the mechanisms linking depression to the risk of HFpEF.