RT Journal Article
SR Electronic
T1 Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e454
OP e461
DO 10.1212/CPJ.0000000000000983
VO 11
IS 4
A1 Cassandra D. Ford
A1 Marquita S. Gray
A1 Martha R. Crowther
A1 Virginia G. Wadley
A1 Audrey L. Austin
A1 Michael G. Crowe
A1 LeaVonne Pulley
A1 Frederick Unverzagt
A1 Dawn O. Kleindorfer
A1 Brett M. Kissela
A1 Virginia J. Howard
YR 2021
UL http://cp.neurology.org/content/11/4/e454.abstract
AB Objective The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.Methods The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003–2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1–3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.Results There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1–3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23–1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11–1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27–1.85), with risk attenuated in the full model similar to risk with 1–3 symptoms (HR = 1.25, 95% CI = 1.03–1.51). There was no evidence of a differential effect by race (p = 0.53).Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.