Depressive symptoms and cardiovascular mortality in older black and white adults evidence for a differential association by race

Background: An emerging body of research suggests that depressive symptoms may confer an "accelerated risk" for cardiovascular disease (CVD) in blacks compared with whitesResearch in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end pointsMethods and Results: The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adultsCox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9- to 12-year follow-upIn race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; P<0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; P=0.11; race by depressive symptoms interaction, P=0.03)Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; P=0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; P<0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; P=0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; P=0.40)Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factorsFindings for stroke were reduced to marginal significanceConclusions: Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whitesFindings were not completely explained by standard risk factorsEfforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health.