Part 1 | Vascular risk factors for depression and apathy 37 2 measured at baseline, and changes in hypertension or functional limitations during the follow-up period. The chronicity of CRDSs during follow-up was an independent predictor of incident stroke (HR, 3.51; 95% CI, 1.13-10.93; P = .03). The chronicity of MDD was not significantly associated with incident stroke (HR, 5.59; 95% CI, 0.77-40.56; P = .09). In addition, the mean severity of depressive symptoms during follow-up was significantly associated with an incident stroke (HR, 1.08; 95% CI, 1.02-1.13; P = .005). Results were similar for men and women, and correction for cardiac medication did not significantly influence the associations found. The CRDSs at baseline were not significantly associated with incident stroke in patients without cardiac disease at baseline (Table 3) and neither were the chronicity of CRDSs nor the mean severity of symptoms during follow-up. Table 3. Multivariate Cox Regression on Incident Stroke after Stratification for Cardiac Disease No cardiac disease (n=2354) Cardiac disease (n=611) Wald HR (95 %-CI) P-level Wald HR (95 % CI) P-level Baseline variablesA MDD 0.64 0.44 (0.06-3.22) .42 1.70 2.66 (0.61-11.56) .19 CRDS 1.15 0.73 (0.41-1.30) .28 5.95 2.18 (1.17-4.09) .02 Depressive symptoms (continuous) 0.90 0.99 (0.96-1.01) .34 8.98 1.05 (1.02-1.08) .003 Time-dependent variablesB Chronicity of MDD 0.42 0.39 (0.02-6.86) .52 2.90 5.59 (0.77-40.56) .09 Chronicity of CRDS 0.02 0.94 (0.38-2.31) .90 4.69 3.51 (1.13-10.93) .03 Mean symptom severity (range, 0-60) 0.64 0.98 (0.94-1.03) .42 7.75 1.08 (1.02-1.13) .005 Abbreviations: CI, confidence interval; CRDSs, clinically relevant depressive symptoms; HR, hazard ratio; MDD, major depressive disorder A Corrected for: age, sex, Mini-Mental State Examination, smoking, functional limitations, hypertension, diabetes mellitus, and obesity. B Corrected for: age, sex, Mini-Mental State Examination, smoking, diabetes mellitus, obesity, functional limitations, and hypertension (baseline) and for a change in functional limitations or hypertension during follow-up (time-dependent). Comment This study shows that cardiac disease moderates the association between CRDSs and incident stroke. In cardiac patients, there seemed to be a dose-response effect in that both the severity and the chronicity of depressive symptoms during follow-up were predictors of incident stroke. This relationship was not observed in patients without cardiac disease at baseline.
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