The risk of stroke may be twice as high in adults older than age 50 years who have persistent symptoms of depression than in those who do not, according to a study published online May 13 in the Journal of the American Heart Association. The risk for stroke is higher even after the depression has resolved, particularly for women.

Lead author Paola Gilsanz, ScD, and colleagues evaluated data on 16,178 men and women aged 50 years and older between 1998 and 2010. Stroke and depressive symptoms were assessed every two years. Stroke was documented by self-report of diagnoses made by attending health care providers and depression by a modified Center for Epidemiologic Studies Depression scale (high was defined as three symptoms or more). The researchers evaluated depressive symptoms (stable low/no, onset, remitted, or stable high) across two successive interviews against the 1,192 incident stroke events that occurred during the subsequent two years. 

People with stable high depressive symptoms at two consecutive interviews were more than twice as likely to have a first stroke, compared with participants who had stable low or no depressive symptoms. The risk for stroke continued to be elevated among participants with remitted depressive symptoms, especially women and non-Hispanic whites. 

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The researchers suggested that depression may influence stroke risk through physiological changes resulting in vascular damage over time or through depression’s effect on poor health behaviors, including smoking and physical inactivity.