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. 2021 Oct-Dec;5(4):112-118.
doi: 10.4103/hm.hm_34_21. Epub 2021 Nov 30.

Somatic Versus Cognitive Depressive Symptoms as Predictors of Coronary Artery Disease among Women with Suspected Ischemia: The Women's Ischemia Syndrome Evaluation

Ashley S Emami  1 , C Noel Bairey Merz  2 , Jo-Ann Eastwood  3 , Carl J Pepine  4 , Eileen M Handberg  4 , Vera Bittner  5 , Puja K Mehta  6 , David S Krantz  7 , Viola Vaccarino  6 , Wafia Eteiba  8 , Carol E Cornell  9 , Thomas Rutledge  1   10
Affiliations

Somatic Versus Cognitive Depressive Symptoms as Predictors of Coronary Artery Disease among Women with Suspected Ischemia: The Women's Ischemia Syndrome Evaluation

Ashley S Emami et al. Heart Mind (Mumbai). 2021 Oct-Dec.

Abstract

Background: Depression is an established predictor of coronary artery disease (CAD) progression and mortality. "Somatic" symptoms of depression such as fatigue and sleep impairment overlap with symptoms of CAD and independently predict CAD events. Differentiating between "somatic" and "cognitive" depressive symptoms in at-risk patients may improve our understanding of the relationship between depression and CAD.

Methods: The study utilized data from the Women's Ischemia Syndrome Evaluation. Participants (N = 641; mean age = 58.0 [11.4] years) were enrolled to evaluate chest pain or suspected myocardial ischemia. They completed a battery of symptom and psychological questionnaires (including the Beck Depression Inventory [BDI]) at baseline, along with quantitative coronary angiography and other CAD diagnostic procedures. The BDI provided scores for total depression and for cognitive and somatic depressive symptom subscales.

Results: Two hundred and fourteen (33.4%) women met criteria for obstructive CAD. Logistic regression models were used to examine relationships between depression symptoms and obstructive CAD. Neither BDI total scores (odds ratio [OR] =1.02, 95% confidence interval [CI], 0.99-1.05, P = 0.053) nor BDI cognitive scores (OR = 1.02, 95% CI, 1.00-1.04, P = 0.15) predicted CAD status. BDI somatic symptom scores, however, significantly predicted CAD status and remained statistically significant after controlling for age, race, and education (OR = 1.06, 95% CI, 1.01-1.12, P = 0.02).

Conclusion: Among women with suspected myocardial ischemia, somatic but not cognitive depressive symptoms predicted an increased risk of obstructive CAD determined by coronary angiography. Consistent with prior reports, these results suggest a focus on somatic rather than cognitive depressive symptoms could offer additional diagnostic information.

Keywords: Beck Depression Inventory; coronary artery disease; depression; ischemia; women.

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Conflict of interest statement

Conflicts of interest There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Item level means for Beck Depression Inventory somatic subscale items. Note: Error bars indicate the standard error of the mean
Figure 2:
Figure 2:
Risk Factor by Somatic Subscale Score. Note: *P<0.01, **P<0.05. Error bars indicate the standard error of the mean. These results are unadjusted for demographic variables. Women who did not have the risk factor are displayed in dark grey, while women with the risk factor are displayed in light grey
Figure 3:
Figure 3:
Rates of Obstructive CAD by Risk Factor. Note: **P<0.001, *P<0.05. These results are unadjusted for demographic variables. Women who did not have the risk factor are displayed in dark grey, while women with the risk factor are displayed in light grey.
See this image and copyright information in PMC

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