TY - JOUR T1 - Depressive symptoms predict incident stroke independently of memory impairments. JF - Neurology Y1 - 2010 A1 - M. Maria Glymour A1 - J Maselko A1 - Gilman, S E A1 - Kristen K Patton A1 - Mauricio Avendano KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Kaplan-Meier Estimate KW - Longitudinal Studies KW - Male KW - Memory Disorders KW - Middle Aged KW - Neuropsychological tests KW - Predictive Value of Tests KW - Risk Factors KW - Statistics, Nonparametric KW - Stroke KW - United States AB -

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of ≤6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

PB - 75 VL - 75 IS - 23 N1 - Glymour, M M Maselko, J Gilman, S E Patton, K K Avendano, M 1R01MH087544/MH/NIMH NIH HHS/United States 1R21 AG34385-01A1/AG/NIA NIH HHS/United States 1R21AG037889-01/AG/NIA NIH HHS/United States 1R21HD066312-01/HD/NICHD NIH HHS/United States 1RC4MH092707-01/MH/NIMH NIH HHS/United States 5R03MH083335/MH/NIMH NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Neurology Neurology. 2010 Dec 7;75(23):2063-70. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21135381?dopt=Abstract U2 - PMC2995534 U4 - Aged, 80 and over/Depression/ etiology/Depression/ etiology/Female/Health Surveys/Humans/Incidence/Kaplan-Meier Estimate/Kaplan-Meier Estimate/Longitudinal Studies/Memory Disorders/complications/ epidemiology/Memory Disorders/complications/ epidemiology/Middle Aged/Neuropsychological Tests/Predictive Value of Tests/Predictive Value of Tests/Risk Factors/Statistics, Nonparametric/Statistics, Nonparametric/Stroke/ complications/ epidemiology/Stroke/ complications/ epidemiology/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study. JF - J Am Geriatr Soc Y1 - 2009 A1 - J Maselko A1 - Lisa M. Bates A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Aged KW - Cardiovascular Diseases KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Risk Factors KW - Sexuality KW - Stroke AB -

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke.

DESIGN: Longitudinal cohort.

SETTING: U.S. national sample, community based.

PARTICIPANTS: U.S. adults aged 50 and older and their spouses.

MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married).

RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95% confidence interval (CI)=1.11-1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95% CI=1.12-1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women.

CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

PB - 57 VL - 57 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19874408?dopt=Abstract U3 - 19874408 U4 - Stroke/risk factors/Marital Status/Sex Differences ER -