Depression Following Myocardial Infarction Raises Stroke Risk in US Adults

Adults with depression following myocardial infarction (MI) were approximately 50% more likely to experience a stroke compared with those who did not have depression, according to new research being presented at the American College of Cardiology’s (ACC) 71st Scientific Sessions, held April 2-4, 2022.

Researchers analyzed the health records of approximately half a million US adults aged 18 to 90 years post-MI and found a key difference in stroke rates between those with and without depression who otherwise had similar demographic and health backgrounds.

"The only difference between these two cohorts is that one has depression," said lead author Frank H. Annie, PhD, research scientist, Department of Cardiology, Charleston Area Medical Center, West Virginia, in an ACC press release. "There could be a multitude of depression-related factors that are leading to these outcomes. What we're seeing in this data is very troubling, and we need to dig deeper to understand the causes and effects."

Frank H. Annie, PhD
Image courtesy of ACC

Annie and colleagues identified patients with MI in the Trinetx database from 2015 to 2021. Trinetx pools electronic medical record data from 58 US health care systems into a single, cloud-based service where researchers can examine several sources of data while protecting patient privacy and security.

A total of 495 386 patients were included in the study who were then divided into those who had a diagnosis of depression post-MI (n=51 670; 10.5%) and those who did not (n=443 716; 89.5%). Patients in both groups were approximately 65 years of age. Investigators compared all-cause stroke-related events between propensity score-matched pairs of participants in those 2 cohorts.

The team found that 12% of participants with depression and 8.3% of those without depression suffered a stroke afterward (P<.01). A few factors could have caused these differences, such as depression interfering with a person’s ability to attend medical appointments and keep up with their medications, according to study authors.

Researchers noted that men were more likely to have depression than women. Adults with depression had higher rates of hypertension, coronary artery disease, diabetes, heart failure, and chronic obstructive pulmonary disease, as well as higher body mass index and a history of smoking. The association between depression and subsequent stroke, however, remained significant after accounting for these variables.

The exact cause of the relationship between depression and cardiovascular disease (CVD) remains unclear, but evidence is accumulating that suggests depression treatment can help improve outcomes in those with CVD. In the current study, 7% of participants with depression had previously used antidepressants.

"A multidisciplinary approach is required," said Annie. "Based on these data, if there's someone who has a history of heart disease and depression, I would advocate for devoting special attention within the health care system to making sure that these individuals are making their appointments and that they're seeing the right providers within the health system."

Annie et al noted that future studies are needed to further understand how depression and other factors may affect an individual’s cardiovascular health and risk of stroke, in addition to other forms of CVD.

“We do answer a few questions, but we’re raising a lot more,” stated Annie.

Annie will present the study, “The Effect of Depression on Post Myocardial Infarction Cases,” virtually on Saturday, April 2, at 8:30 a.m. ET / 12:30 UTC.