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(Stroke. 2007;38:16.)
© 2007 American Heart Association, Inc.

Original Contributions

Depressive Symptoms and Risk of Stroke

The Framingham Study

Kimberly J. Salaycik, MA; Margaret Kelly-Hayes, EdD, RN; Alexa Beiser, PhD; Anh-Hoa Nguyen, MA; Stephen M. Brady, PhD; Carlos S. Kase, MD Philip A. Wolf, MD

From the Department of Neurology (K.J.S., M.K.-H., A.B., C.S.K., P.A.W.), Framingham Heart Study, Boston University School of Medicine; the Department of Biostatistics (A.B., A.-H.N.), School of Public Health, Boston University, and the Department of Psychiatry (S.M.B.), Graduate Medical Sciences, Boston University School of Medicine, Boston, Mass.

Correspondence and reprint requests to Margaret Kelly-Hayes, EdD, RN, Department of Neurology/Framingham Heart Study, Boston University School of Medicine, 715 Albany St, B-608B, Boston, MA 02118-2526. E-mail mkhayes{at}bu.edu

Background and Purpose— Emerging evidence raises the possibility of an association between depression and stroke risk. This study sought to examine whether depressive symptoms are associated with an increased risk of cerebrovascular events in a community-based sample.

Methods— A prospective study was conducted on 4120 Framingham Heart Study participants aged 29 to 100 years with up to 8 years of follow-up. The Center for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Incident stroke and transient ischemic attack (TIA) events were assessed by uniform diagnostic criteria. The association between depressive symptoms and risk of stroke/TIA was analyzed with Cox proportional-hazards models, after adjusting for traditional stroke risk factors.

Results— In participants <65 years, the risk of developing stroke/TIA was 4.21 times greater (P=<0.001) in those with symptoms of depression. After adjusting for components of the Framingham Stroke Risk Profile (hazard ratio=3.43, 95% CI=1.60 to 7.36, P=0.002) and education (hazard ratio=4.89, 95% CI=2.19 to 10.95), similar results were obtained. In subjects aged 65 and older, depressive symptoms were not associated with an increased risk of stroke/TIA. Taking antidepressant medications did not alter the risk associated with depressive symptoms.

Conclusions— In this community-based study, depressive symptoms were an independent risk factor for incident stroke/TIA in individuals <65 years. These data suggest that identification of depressive symptoms at younger ages may have an impact on the primary prevention of stroke.

Key Words: depressive symptoms • stroke • transient ischemic attack • risk factors

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