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(Circulation. 2008;117:2313-2319.)
© 2008 American Heart Association, Inc.

Cardiovascular Surgery

Depressive Symptoms and the Risk of Atherosclerotic Progression Among Patients With Coronary Artery Bypass Grafts

Gregory A. Wellenius, ScD; Kenneth J. Mukamal, MD, MPH; Ambar Kulshreshtha, MB, MPH; Sharon Asonganyi, MPH; Murray A. Mittleman, MD, DrPH

From the Cardiovascular Epidemiology Research Unit (G.A.W., A.K., S.A., M.A.M.) and Division of General Medicine and Primary Care (K.J.M.), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Boston University School of Public Health (S.A.), Boston, Mass; and Department of Epidemiology (M.A.M.), Harvard School of Public Health, Boston, Mass.

Correspondence to Gregory A. Wellenius, ScD, Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Room 442, Boston, MA 02215. E-mail gwelleni{at}bidmc.harvard.edu

Received September 18, 2007; accepted March 7, 2008.

Background— Depressive symptoms have been associated with increased risk of coronary artery disease and poor prognosis among patients with existing coronary artery disease, but whether depressive symptoms specifically influence atherosclerotic progression among such patients is uncertain.

Methods and Results— The Post-CABG Trial randomized patients with a history of coronary bypass graft surgery to either an aggressive or a moderate lipid-lowering strategy and to either warfarin or placebo. Coronary angiography was conducted at enrollment and after a median follow-up of 4.2 years. Depressive symptoms were assessed at enrollment with the Centers for Epidemiologic Studies Depression scale (CES-D) in 1319 patients with 2496 grafts. In models that adjusted for age, gender, race, treatment assignment, and years since coronary bypass graft surgery, a CES-D score 16 was positively associated with risk of substantial graft disease progression (OR 1.50, 95% CI 1.08 to 2.10, P=0.02) and marginally associated with a 0.11-mm (95% CI –0.22 to 0.01 mm, P=0.07) decrease in minimum lumen diameter, but not with risk of graft occlusion (P=0.30). Additional adjustment for past medical history, blood pressure, and renal function did not materially alter these results. This association was virtually absent among participants randomly assigned to aggressive lipid-lowering therapy.

Conclusions— These findings suggest that depressive symptoms are associated with a higher risk of atherosclerotic progression among patients with saphenous vein grafts and that aggressive lipid lowering can minimize this increased risk. Whether depressive symptoms increase progression in other types of coronary atherosclerosis and whether aggressive lipid lowering attenuates such progression will require additional study.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 117: 2309-2310. [Full Text]