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1 National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy.
2 Istituto Superiore di Sanità, Rome, Italy.
3 National Research Council, Institute of Neuroscience, Florence, Italy.
Address correspondence to Stefania Maggi, MD, MPH, CNR Center on Aging, c/o Clinica Medica 1, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy. E-mail: smaggi{at}unipd.it
Background. Studies on the association between depressive symptomatology (DS) and cardiovascular events and mortality in elderly persons have yielded contradictory findings. To address this issue, the authors assessed DS and an extensive array of sociodemographic, behavioral, and biological variables in the largest population-based sample of older Italians ever studied and analyzed their association with coronary heart disease (CHD) morbidity and total number of deaths.
Methods. This prospective, community-based cohort study included a sample of 5632 Italians, 65 years and older, who were recruited from the demographic registries of eight municipalities in Italy. Depressive symptomatology was assessed using the Geriatric Depression Scale, and a score 
10 was used to indicate the presence of DS. All traditional cardiovascular disease risk factors were assessed at baseline, through questionnaires, blood tests, and physical examinations. The outcomes were CHD fatal and nonfatal events and total number of deaths. The association of the predictive variables with the outcomes was assessed using different Cox models.
Results. Baseline DS was associated with a higher incidence of fatal and nonfatal CHD events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.06–2.60) and with cardiovascular mortality in men (HR, 2.49; 95% CI, 1.60–3.87) and with total mortality in men (HR, 2.02; 95% CI, 1.58–2.58) and women (HR, 1.43; 95% CI, 1.04–1.95) at the 4-year follow-up assessment. This association was observed after adjusting for a vast array of potential confounding variables, including major chronic conditions.
Conclusions. Depressive symptomatology confers an increased risk for CHD in men and for total mortality in men and women but is not explained by health behaviors, social isolation, or biological or clinical determinants.
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