With interest, we have read the article of Wassertheil-Smoller et al1 on depression and cardiovascular sequelae in postmenopausal women. The authors report that depression is an independent risk factor for cardiovascular mortality and all-cause mortality among postmenopausal women being studied in the Women’s Health Initiative Observation Study. However, as the effect of depression on noncardiovascular mortality is not described, it remains unclear whether depression specifically increases cardiovascular mortality. Therefore, we calculated the mortality risks of depressed women by using the event rates as presented by the authors. It appears that depressed women were at an increased risk for both cardiovascular (relative risk, 1.52; 95% confidence interval, 1.26-1.83) and noncardiovascular mortality (relative risk, 1.25; 95% confidence interval, 1.12-1.40) (Table). Therefore, it is more likely that depression increases mortality through aspecific mechanisms such as noncompliance with medical treatment rather than through specific biological mechanisms affecting cardiovascular disease risk.2 We do not know if this conclusion extends to women without cardiovascular disease at baseline because we could not calculate the noncardiovascular mortality in these subjects from the presented data.
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