Perinatal Depression May Increase Risk of Cardiovascular Disease in Women

Women with perinatal depression (PND) are at higher risk of developing cardiovascular disease (CVD), according to the authors of a study published in the European Heart Journal. Previous research has shown that depression and other major-depressive disorders are risk factors for developing CVD. These findings may help clinicians better identify early signs of CVD in high-risk patients for early prevention, detection, and intervention.

The findings presented in the study underscore the need for increased women’s representation in clinical trials to better understand the high-risk factors contributing to CVD in women and promote timely interventions for affected patients. Image Credit: © Laia Balart - stock.adobe.com

According to the Anxiety and Depression Association of America, women are 2 to 3 times more likely than men to develop depression and other depression-related illnesses, such as premenstrual dysphoric disorder (PMDD), postpartum depression, perinatal depression, and postmenopausal depression.1 Studies investigating prevalence of depression in women find potential links to societal and environmental factors; however, researchers also observe correlations between depression and hormonal changes, suggesting hormonal fluctuations may trigger depression. These biological factors, such as the decrease of estrogen, which has a protective effect on the brain against depression, may explain the higher prevalence of depression in women.²

Depression, anxiety, and stress are known risk factors for developing CVD as a result of prolonged high heart rate and blood pressure, which reduces blood flow to the heart and increases cortisol production. Over time, these effects increase risk of adverse cardiac events, such as heart attack or stroke, and the subsequent development of heart disease. Women have historically been underrepresented in cardiovascular trials, creating a significant gap in our understanding of CVD in women which impacts the quality of care they receive.³ The findings presented in the study underscore the need for increased women’s representation in clinical trials to better understand the high-risk factors contributing to CVD in women and promote timely interventions for affected patients.

The study from the Karolinska Institutet in Stockholm, Sweden investigated 55,539 women diagnosed with PND between 2001 and 2014 compared with 545,567 unaffected women. Women were paired based on age, year of conception, and delivery, and then monitored until 2020. Instances of both PND and CVD were identified using data from the Swedish national health register, and were characterized by either a diagnosis of depression or the prescription of antidepressant medications.^4,5

Follow-up data collected in 2020 demonstrated that women with PND had a 36% higher risk of developing CVD (adjusted hazard ratio [HR] = 1.36, 95% CI: 1.31–1.42) compared with unaffected women, who had a 20% higher risk of CVD (adjusted HR = 1.20, 95% CI 1.07–1.34). Due to the large sample size, the study authors also included a sibling-match cohort of 13,804 women with PND and their 16,420 unaffected siblings, observing that women with PND still had a 20% higher risk compared with their siblings.^4,5

Additionally, the data suggest women with PND experience an earlier onset of CVD at a higher percentage (6.4%) compared with unaffected women (3.7%). The results also identified a significantly higher association between PND and hypertensive disease (HR = 1.50, 95% CI: 1.41–1.60), compared with ischemic heart disease (HR = 1.37, 95% CI: 1.13–1.65) and heart failure (HR 1.36, 95% CI: 1.06–1.74).^4,5

The study authors noted some limitations, including evolving definitions of PND over time that constrained diagnostic precision, instances of PND diagnosed without antidepressant prescriptions, and cases where women with PND did not seek health care. However, the nationwide population-based design enabled the investigators to utilize a large sample size for comprehensive, stratified analyses examining the associations between PND and CVD in women.⁴

Due to the historic focus on men in clinical research, important risk factors for CVD in women are largely misunderstood. The findings emphasize the need for continued research of CVD in women to better understand the risk factors and biological predispositions that increase their vulnerability, enabling clinicians to provide more timely and effective care.

REFERENCES

1. Women and depression. Anxiety and Depression Association of America. Accessed June 26, 2024. https://adaa.org/find-help-for/women/depression
2. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. July 2015. doi:10.1503/jpn.150205
3. How to stay heart healthy—even when you’re down. American Heart Association. June 22, 2021. Accessed June 26, 2024. https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/how-does-depression-affect-the-heart
4. Lu D, Valdimarsdóttir U, Wei D, Chen Y, et al. Perinatal depression and risk of maternal cardiovascular disease: a Swedish nationwide study. European Heart Journal. June 18, 2024. doi:10.1093/eurheartj/ehae170