Vascular risk factors for depression and apathy | Part 1 36 Interaction between cardiac disease and depressive symptoms Fully corrected survival functions for incident stroke, stratified for cardiac disease status and the presence of CRDSs, are presented in the Figure. The hazard for incident stroke was higher in those with cardiac disease and CRDSs compared with those with cardiac disease but without CRDSs. Multivariate Cox proportional hazards regression demonstrated that inclusion of the interaction term CRDS × cardiac disease (HR, 2.46; 95% CI, 1.095.56; P = .03) significantly improved the model for incident stroke (χ2 = 4.7, P = .03), as did inclusion of the interaction term depressive symptoms × cardiac disease (HR, 1.06; 95% CI, 1.01-1.11; P = .01). Other potentially relevant interaction terms, such as depressive symptoms × diabetes mellitus (P = .65), depressive symptoms × stage 1 hypertension (P = .69), depressive symptoms × stage 2 hypertension (P = .93), and depressive symptoms × smoking (P = .85), were not significantly related to incident stroke Figure 1. Survival Function (Cox regression) for Incident Stroke at Means of Covariates. CD indicates cardiac disease; CRDSs, clinically relevant depressive symptoms Abbreviations: CRDS, clinically relevant depressive symptoms; CD, cardiac disease Depressive symptoms and incident stroke in patients with and without cardiac disease Stratification of the sample into those with or without cardiac disease at baseline showed that in patients with cardiac disease the presence of CRDSs at baseline was associated with a higher incidence of stroke even after correction for possible confounders (HR, 2.18; 95% CI, 1.17-4.09; P = .02) (Table 3). The extended multivariate Cox proportional hazards regression model for first stroke included time-dependent depression variables (the mean severity of depressive symptoms, the chronicity of CRDSs, and the chronicity of MDD), possible confounders 10 0 1 2 3 4 5 6 7 8 9 Years of follow-up 1,000 0,975 0,950 0,925 0,900 0,875 Cum Survival CD no and CRDSs no CD no and CRDSs yes CD yes and CRDSs no CD yes and CRDSs yes (p=0.3) s f fol ow-up Cum Survival
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