Association of depression with coronary artery disease and QTc interval prolongation in women with chest pain: Data from the KoRean wOmen'S chest pain rEgistry (KoROSE) study

Abstract

The presence of depression is reportedly related with cardiovascular diseases, including coronary artery disease (CAD), but little is known concerning the association between depressive symptoms reflecting the cultural constructions of female patients with chest pain as well as coronary artery stenosis, coronary vasospasm, and the corrected QT (QTc) interval. In a multicenter prospective cross-sectional survey of 163 Korean women with chest pain, the presence of depression was evaluated using the Beck Depression Inventory (BDI) and Lee and Rhee Depression (LRD) scales. The differences in the QTc interval and the presence of CAD (defined as >= 50% coronary artery stenosis on coronary angiography) and coronary vasospasm were compared between depressed and non-depressed women. Significant CAD was present in 83 of 163 female patients (mean age, 61 years), and coronary vasospasm was present in 11 of 80 patients. The mean BDI and LED scores were significantly higher in patients with significant CAD (BDI: 13.4 +/- 9.6 vs. 6.9 +/- 5.6, p < 0.001; LED: 46.9 +/- 21.4 vs. 39.8 +/- 15.2, p = 0.027) and coronary vasospasm (BDI: 12.3 +/- 6.4 vs. 4.6 +/- 2.8; and LED: 49.8 +/- 123 vs. 30.5 +/- 13.9; both p < 0.05). On multivariate analysis, BDI scores were important risk factors for the presence of CAD (odds ratio [OR] = 1.138; 95% confidence interval [Cl] = 1.071-1210; p = 0.021) and coronary vasospasm (OR = 2.534; 95% CI = 1.161-2.028; p = 0.003), with similar findings obtained for LRD scores (CAD: OR = 1.034; 95% CI = 1.013-1.056; p = 0.001; coronary vasospasm: OR = 1.125; 95% Cl = 1.050-1.206; p = 0.001). The mean QTc interval was also significantly higher in the depressed group than in the non-depressed group (440.1 +/- 32.0 ms vs. 408.2 +/- 26.4 ms; p < 0.001). The QTc interval displayed significant positive with the BDI (r = 0.595; p < 0.001) and LED scores (r = 0.467; p < 0.001). This study demonstrated that depression is associated with a prolonged QTc interval, CAD, and coronary vasospasm in female patients with chest pain, suggesting a possible mechanism by which depressive mood may be linked with coronary endothelial dysfunction and atherosclerosis. (C) 2015 Elsevier Inc. All rights reserved.