Depression and Risk of Heart Failure Among Older Persons With Isolated Systolic Hypertension

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Abstract
INVESTIGATORS have shown that depression is associated with an increased risk of developing coronary heart disease in general1-3 and myocardial infarction (MI) in particular.3,4 Studies5-8 have also shown that depression is a negative prognostic factor among persons with established coronary heart disease. Less is known about the relationship between depression and heart failure. One study9 reported an association between depression and higher death rates among persons with existing heart failure. However, prior investigations have not addressed whether depression predicts the onset of heart failure. Because depression is associated with increased MI risk and because MI is a major risk factor for heart failure, one would expect depression to be associated with an increased risk of developing heart failure. In addition, however, depression has been associated with excessive activation of the sympathetic nervous system,10,11 and heightened activation of this system is thought to be one of the processes involved in the pathogenesis of heart failure.12 As such, depression-induced sympathetic nervous system activation represents a separate pathway, not necessarily related to MI risk, by which depression could increase the risk of incident heart failure. If a link were established between depression and increased risk of heart failure, it would add to the growing evidence of depression's negative impact on cardiovascular health. In the present study, we examined whether depression was predictive of incident heart failure among older persons with isolated systolic hypertension enrolled in the Systolic Hypertension in the Elderly Program (SHEP).