Mood Problems Increase the Risk of Mortality in Patients With Lacunar Infarcts: the SMART-MR Study

Psychosomatic Medicine, 04/06/2012

Patients with lacunar infarcts may be especially vulnerable for the effect of mood problems on mortality.


  • Mood problems were assessed with the mental component summary of the 36-item Short-Form Medical Outcomes Study in 1110 patients with symptomatic atherosclerotic disease (mean age 59 years).
  • Volumetric WML estimates were obtained with 1.5-T magnetic resonance imaging; lacunar infarcts were scored visually.
  • Cox regression models were adjusted for age, sex, vascular risk, physical functioning, antidepressants and infarcts.
  • The authors adjusted for CSVD to examine whether it may be an intermediate or confounding factor.
  • Second, the authors added interaction terms to investigate whether associations differed between patients with CSVD (absent/present).


  • Patients in the lowest quartile of mental functioning, representing most severe mood problems, were at higher, although not significant, risk of death (hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 0.94–2.30) compared with patients in higher quartiles.
  • Adjustment for CSVD did not change this association.
  • Lacunar infarcts, not WML, modified the association of mood problems with mortality (p value for interaction = .01); mood problems strongly increased the risk of mortality in patients with lacunar infarcts (HR = 2.75, 95% CI = 1.41–5.38) but not in those without it (HR = 0.78, 95% CI = 0.39–1.57).

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