Cardiovascular risk factors and risk of incident depression throughout adulthood among men: The Johns Hopkins Precursors Study

Prevalence of depression and its network structure and association with quality of life in older adults with hypertension: findings of a national survey

INTRODUCTION

Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study aimed to examine the prevalence and correlates of depression, and its network structure and association with quality of life (QOL) in older adults with hypertension.

METHODS

Depression and QOL were measured using the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD-10) and the World Health Organization Quality of Life-brief version, respectively. Univariable and multivariable analyses were performed. Network analysis was used to explore the interconnections between depressive symptoms. The flow function was used to identify depressive symptoms that were directly associated with QOL.

RESULTS

A total of 5032 older adults with hypertension were included. The prevalence of depression (CESD-10 total score ≥ 10) was 28.3% (95% confidence interval: 27.08%-29.59%), which was significantly associated with poor QOL (P < 0.001). Participants who were male (P < 0.001), resided in urban areas (P = 0.006), lived with their family (P < 0.001), had perceived fair or good economic status (P < 0.001), and higher level of instrumental activities of daily living (P < 0.001) had lower risk of depression. In the network model of depression, CESD3 'Feeling blue/depressed', CESD4 'Everything was an effort' and CESD8 'Loneliness' were the most central symptoms. CESD10 'Sleep disturbances' had the highest negative association with QOL, followed by CESD5 'Hopelessness', and CESD7 'Lack of happiness'.

CONCLUSION

Depression was common among older adults with hypertension and significantly associated with poor QOL. To prevent and reduce the negative impact of depression in this population, appropriate interventions should target both central symptoms and the depressive symptoms associated with QOL.

Association between plant-based diets and depression in older adults with heart disease: the mediating role of sleep disturbances

Background

Depression is not uncommon among older adults with heart diseases and is related to poor prognosis at clinical setting. We aim to explore the association between plant-based diets and depression in older adults with heart disease and further investigate the mediating role of sleep disturbances in this relationship.

Methods

A cross-sectional sample of 2039 older adults with heart diseases were recruited from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Each individual completed assessments on dietary frequency, depression, sleep quality and duration. Plant-based diet index (PDI), healthy plant-based diet index (hPDI) and unhealthy plant-based diet index (uPDI) were calculated. Logistic regression models and restricted cubic spline curves (RCS) were employed to explore the relationship between plant-based diets and depression in older adults with heart disease. Meanwhile, mediation analysis was used to investigate the mediating roles of sleep quality and sleep duration.

Results

The higher the PDI (OR: 0.56, 95% CI: 0.36-0.88) and the hPDI (OR: 0.39, 95% CI: 0.24-0.62), the lower the risk of depression in older adults with heart disease. Conversely, the higher the uPDI, the higher the risk of depression (OR: 1.76, 95% CI: 1.07-2.92). RCS further confirmed a negative linear dose-response relationship between PDI, hPDI and depression in older adults with heart disease, and a positive trend was found between uPDI and depression. Notably, sleep quality (Indirect effect: -0.031, mediated proportion: 61%) partially mediated the relationship between PDI and depression. In the sex-based subgroup analysis, uPDI was only associated with a higher risk of depression in females.

Conclusion

This is the first study to suggest a significant negative relationship between plant-based diets and depression in older adults with heart disease. Sleep quality plays a mediating role in the association between plant-based diets and depression. Optimizing the dietary structure and improve sleep quality may help reduce the risk of depression in older adults with heart disease.

Exploring the causal effects of physical activity, diet, and nutrition on hypertension and hyperlipidemia: a multivariable Mendelian randomization analysis

BACKGROUND AND AIM

Hypertension and hyperlipidaemia are major risk factors for cardiovascular diseases, contributing to significant morbidity and mortality worldwide. Lifestyle interventions, including modifications in diet, nutrition, and physical activity, are commonly recommended, but their causal effects on these conditions remain uncertain. This study aims to explore the causal effects of these factors on hypertension and hyperlipidaemia using multivariate Mendelian randomisation analysis, providing insights for effective cardiovascular prevention strategies.

METHODS AND RESULTS

Genetic data related to physical activity, diet, and nutrition were obtained from public databases and analyzed using multivariate Mendelian randomisation. The analysis employed MR Egger, weighted median, and inverse variance weighting (IVW) methods, with tests for heterogeneity and multiplicity ensuring the reliability of the results. In the hypertension analysis, low-calorie diets showed a positive association in weighted median and IVW analyses, with weighted median analysis showing an association of 1.122 (95% CI: 1.014-1.243, P = 0.026) and IVW analysis showing an association of 1.095 (95% CI: 1.013-1.184, P = 0.023). However, MR Egger's analysis showed no significant association (association of 0.688, 95% CI: 0.411-1.155, P = 0.230). Calcium supplements and dietary fibre did not demonstrate significant associations across all methods. Physical activity also did not show significant causal links with hypertension. Regarding hyperlipidaemia, calcium supplements exhibited significant effects across all methods, though with notable variation, while dietary fibre and physical activity showed no significant impacts.

CONCLUSIONS

The study suggests a positive association between low-calorie diets and hypertension, as indicated by significant results from weighted median and IVW analyses. Other dietary factors, physical activity, and calcium supplementation exhibited varied or non-significant effects on hypertension and hyperlipidaemia. These findings highlight the need for further research to understand the underlying mechanisms and support the development of effective public health interventions.

Association between depression and vascular aging: a comprehensive analysis of predictive value and mortality risks

BACKGROUND

Depression is a significant global health concern, projected to become the leading disease burden. Vascular burden has been implicated in the pathogenesis of depression. Conversely, whether depression independently influences the process of vascular aging is unknown. This study aims to investigate the mutual relationship between vascular age and depression.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES), the study included 27,764 participants after exclusions. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Vascular aging was assessed by estimated pulse wave velocity (ePWV) and the heart age/vascular age (HVA) based on Framingham Risk Score (FRS). The study employed weighted logistic regression and Cox proportional hazards models to analyze the association between vascular age and depression as well as its mortality risk. Mendelian randomization was utilized to explore the causal associations.

RESULTS

Individuals with depression exhibited a higher risk of an advanced vascular age over their chronological age. Mendelian randomization analysis indicated a causal relationship between depression and arterial stiffness. A significant association was found between vascular age and depression incidence with odds ratios ranging from 1.10 to 1.38. As vascular age increased, the risk of mortality in individuals with depression increased by 22 % and 46 %, respectively.

LIMITATIONS

The study design limits the exploration of the dynamic relationship between changes in vascular age and depression due to the single timepoint measurement.

CONCLUSION

This study highlights the bidirectional relationship between depression and vascular age. Vascular age is a significant biomarker for the risk and prognosis of depression, while depression may contribute to vascular aging, which underscores the importance of integrated strategies for managing both vascular health and depression.

Bidirectional Associations Between Cardiometabolic Multimorbidity and Depression and Mediation of Lifestyles: A Multicohort Study

Background

Cardiometabolic multimorbidity (CMM) and depression are major health concerns, and the onset of either condition may heighten the risk of developing the other.

Objectives

The goal of this study was to characterize the reciprocal associations between CMM and depression among middle-aged and older adults.

Methods

This multicohort study used harmonized data from 5 prospective cohorts from China, South Korea, the United States, the United Kingdom, and Europe. Cardiometabolic diseases (CMDs) (including diabetes, heart diseases, and stroke) and depression were assessed at baseline and at 7 to 8 years' follow-up. Lifestyle factors, including physical activity, alcohol consumption, and smoking status, were regarded as potential mediators. Two sets of analyses, CMM-depression analyses (n = 67,188) and depression-CMM analyses (n = 65,738), were conducted to explore the bidirectional associations between CMM and depression.

Results

In the CMM-depression analyses, 16,596 (24.7%) individuals developed depression. Participants with a single CMD (HR: 1.24; 95% CI:1.19-1.29) and CMM (HR: 1.52; 95% CI: 1.42-1.63) at baseline had higher risks of depression occurring. Physical activity and alcohol consumption significantly mediated 7.5% and 6.9% of the CMM-depression association, respectively. In the depression-CMM analyses, 1,461 (2.2%) participants developed CMM. The HR for developing CMM was 1.31 (95% CI: 1.14-1.50) in patients with depression, with increased risk of developing more CMDs. Physical activity and alcohol consumption mediated 12.0% and 7.1% of the depression-CMM association. The bidirectional relationships were more pronounced in Western countries than in Asian countries.

Conclusions

CMM and depression were bidirectionally associated. The mediated effects of lifestyle factors were larger in the depression-lifestyle-CMM pathway than in the CMM-lifestyle-depression pathway.

The moderating effect of dietary selenium intake on the risk of infertility-associated depressive symptoms in female

AIM

To analyze the associations between infertility or dietary selenium intake and depressive symptoms as well as the role of selenium intake on the association between infertility and depressive symptoms in women.

METHODS

This study retrieved the data of 4949 women from National Health and Nutrition Examination Survey (NHANES) database. Univariable and multivariable weighted logistic regression analyses were applied to assess the associations of selenium intake or infertility with the risk of depressive symptoms as well as the regulation of selenium intake on the risk of depressive symptoms related to infertility.

RESULTS

The elevated risk of depressive symptoms was found in participants with infertility (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.11-2.15). The risk of depressive symptoms was reduced in women with selenium intake ≥55 μg (OR = 0.64, 95%CI: 0.46-0.90). Compared with women without infertility who had selenium intake <55 μg, those with infertility and had selenium intake <55 μg were associated with elevated risk of depressive symptoms after adjusting for confounding factors (OR = 2.01, 95%CI: 1.03-3.90). The risk of depressive symptoms was not significantly increased in women with infertility who had selenium intake ≥55 μg in comparison with subjects without infertility who had selenium intake ≥55 μg (p > 0.05).

CONCLUSION

Selenium intake regulated the association between infertility and depressive symptoms.

Metabolic Profile and Long-Term Risk of Depression, Anxiety, and Stress-Related Disorders

Importance

Biomarkers of lipid, apolipoprotein, and carbohydrate metabolism have been previously suggested to be associated with the risk for depression, anxiety, and stress-related disorders, but results are inconsistent.

Objective

To examine whether the biomarkers of carbohydrate, lipid, and apolipoprotein metabolism are associated with the risk of depression, anxiety, and stress-related disorders.

Design, Setting, and Participants

This population-based cohort study with longitudinal data collection assessed 211 200 participants from the Apolipoprotein-Related Mortality Risk (AMORIS) cohort who underwent occupational health screening between January 1, 1985, and December 31, 1996, mainly in the Stockholm region in Sweden. Statistical analysis was performed during 2022 to 2023.

Exposures

Lipid, apolipoprotein, and carbohydrate biomarkers measured in blood.

Main Outcomes and Measures

The associations between biomarker levels and the risk of developing depression, anxiety, and stress-related disorders through the end of 2020 were examined using Cox proportional hazards regression models. In addition, nested case-control analyses were conducted within the cohort, including all incident cases of depression, anxiety, and stress-related disorders, and up to 10 control individuals per case who were individually matched to the case by year of birth, sex, and year of enrollment to the AMORIS cohort, using incidence density sampling. Population trajectories were used to illustrate the temporal trends in biomarker levels for cases and controls.

Results

A total of 211 200 individuals (mean [SD] age at first biomarker measurement, 42.1 [12.6] years; 122 535 [58.0%] male; 188 895 [89.4%] born in Sweden) participated in the study. During a mean (SD) follow-up of 21.0 (6.7) years, a total of 16 256 individuals were diagnosed with depression, anxiety, or stress-related disorders. High levels of glucose (hazard ratio [HR], 1.30; 95% CI, 1.20-1.41) and triglycerides (HR, 1.15; 95% CI, 1.10-1.20) were associated with an increased subsequent risk of all tested psychiatric disorders, whereas high levels of high-density lipoprotein (HR, 0.88; 95% CI, 0.80-0.97) were associated with a reduced risk. These results were similar for male and female participants as well as for all tested disorders. The nested case-control analyses demonstrated that patients with depression, anxiety, or stress-related disorders had higher levels of glucose, triglycerides, and total cholesterol during the 20 years preceding diagnosis, as well as higher levels of apolipoprotein A-I and apolipoprotein B during the 10 years preceding diagnosis, compared with control participants.

Conclusions and Relevance

In this cohort study of more than 200 000 participants, high levels of glucose and triglycerides and low levels of high-density lipoprotein were associated with future risk of depression, anxiety, and stress-related disorders. These findings may support closer follow-up of individuals with metabolic dysregulations for the prevention and diagnosis of psychiatric disorders.

Observational and genetic analyses of the bidirectional relationship between depression and hypertension

BACKGROUND

While the association between depression and hypertension has been extensively investigated, the pattern and nature of such association remain inconclusive. We sought to investigate the bidirectional relationship between depression and hypertension and its causal.

METHODS

We first performed observational analyses using longitudinal data from the UK Biobank. We then performed genetic analyses leveraging summary statistics from large-scale genome-wide association studies (GWASs) conducted in European ancestry for depression and hypertension.

RESULTS

Observational analysis suggested a significant bidirectional phenotypic association between depression and hypertension (Depression → Hypertension: HR = 1.27, 95 % CI: 1.19, 1.36; Hypertension → Depression: HR = 1.65, 95 % CI: 1.58, 1.72). Linkage disequilibrium score regression demonstrated a positive genetic correlation between the two conditions (rg=0.15, P = 5.75 × 10-10). Bidirectional two-sample Mendelian randomization (MR) suggested that genetic liability to depression was significantly associated with an increased risk of hypertension (OR = 1.27, 95 % CI: 1.12, 1.43), while the genetic liability to hypertension was not associated with the risk of depression (OR = 1.01, 95 % CI: 0.99, 1.03). Multivariate MR, after adjusting for smoking, drinking, and body mass index, further supported an independent causal effect of genetic liability to depression on hypertension risk (OR = 1.10, 95 % CI: 1.02, 1.18).

LIMITATIONS

(1) interference of confounders, (2) absence of adequate statistical power, and (3) limitation to European populations.

CONCLUSION

Our study indicates depression is a causal risk factor for hypertension, whereas the reverse maybe not. Findings support that prevention of depression might help in decreasing hypertension incidence.

Hypertension, socioeconomic status and depressive and anxiety disorders: a cross-sectional study of middle-aged and older Chinese women

OBJECTIVES

To investigate the association of hypertension with depressive and anxiety disorders in middle-aged and older Chinese women, and to further assess whether the association was influenced by socioeconomic status (SES).

DESIGN

Nationwide cross-sectional study.

SETTING

Six provinces of the eastern, central and western regions of China.

PARTICIPANTS

Women aged 40-70 years were included by a multistage stratified random cluster sampling in 2018 (N=9900).

PRIMARY OUTCOME MEASURES

Depressive and anxiety disorders were measured by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. Logistic regression models were used to evaluate the OR and 95% CI for hypertension and the odds of depressive and anxiety disorders.

RESULTS

18.5% of participants reported having hypertension; 20.9% and 15.3% of women experienced depressive and anxiety disorders, respectively. After adjusting for potential confounders, women diagnosed with hypertension were more likely to have depressive (OR=1.27, 95% CI 1.11 to 1.45) and anxiety disorders (OR=1.48, 95% CI 1.28 to 1.71) than those without hypertension. Stratified analyses demonstrated that hypertension was significantly associated with higher odds of depressive disorders in women living in rural areas (OR=1.34, 95% CI 1.13 to 1.59), with lower levels of education (OR=1.28, 95% CI 1.12 to 1.46) and with average monthly household income <¥3000 (OR=1.33, 95% CI 1.12 to 1.59), while hypertension was significantly correlated with increased odds of anxiety disorders in women living in urban (OR=1.41, 95% CI 1.12 to 1.79) and rural areas (OR=1.53, 95% CI 1.27 to 1.84), with lower levels of education (OR=1.47, 95% CI 1.27 to 1.70), and with average monthly household income <¥3000 (OR=1.45, 95% CI 1.20 to 1.75) and ≥¥3000 (OR=1.49, 95% CI 1.18 to 1.86).

CONCLUSIONS

Hypertension was associated with increased odds of depressive and anxiety disorders among middle-aged and older women, especially in those with low SES. Effective strategies and actions for identification and management of hypertension and depressive and anxiety disorders are needed.

Mediation of the Association Between Vascular Risk Factors and Depressive Symptoms by C-Reactive Protein

Background

This study examined whether C-reactive protein (CRP), a marker of low-grade systemic inflammation, mediates the association between vascular risk factor (VRF) burden and depressive symptoms.

Methods

We drew on the prospective design of the UK Biobank to include participants with longitudinal data on VRF burden, CRP, and depressive symptoms. Total, direct, and indirect effects were estimated using regression-based mediation models while controlling for confounding by sociodemographic factors, baseline CRP, and baseline depression. Sensitivity analyses probed the robustness of results to unmeasured confounding.

Results

We analyzed data from 10,470 participants from the UK Biobank (mean age = 56.75 years at baseline). Net of covariates, VRFs at baseline were associated with higher depressive symptoms at follow-up (total effect = 0.099; 95% CI, 0.002-0.163). CRP mediated this association (indirect effect = 0.010; 95% CI, 0.004-0.017), accounting for 10.0% (95% CI, 0.3%-30.0%) of the total effect of VRF burden on depressive symptoms. Exploratory analyses suggested that the total and indirect effects pertained to somatic depressive symptoms (tiredness and appetite).

Conclusions

These results suggest that inflammation-promoting effects of VRFs may contribute to depressive symptoms in mid- and later life. However, the mediating pathway via CRP explains only a small part of the association between VRFs and depression after accounting for important covariates and may pertain to specific depressive symptoms. Future studies leveraging similar longitudinal designs are needed to further disentangle the time-varying effects between VRFs, inflammation, and certain depressive symptoms while addressing important confounders.

Effect of gender on the association between cumulative cardiovascular risk factors and depression: results from the US National Health and Nutrition Examination Survey

Background

The comorbidity of cardiovascular disease (CVD) and depression has been well established, as depression usually presents simultaneously with CVD risk factors. However, the potential association between cumulative exposure to CVD risk and depression remains unclear, so we conducted the current investigation. To our knowledge, this is the first study that employs the cumulative risk model to examine the effect of CVD risk factors on depression using nationally representative population and gender, age and CVD status-stratified subpopulations.

Aims

To systematically study the possible individual and cumulative effect of 18 CVD risk factors on depression.

Methods

A cross-sectional, secondary analysis investigated associations between 18 CVD risk factors and depression. The interaction effect between CVD risk factors and age, gender and CVD status was also examined. Enrolment included 20 816 participants from the US National Health and Nutrition Examination Survey 2005-2016. Participants with Patient Health Questionnaire-9 scores over 15 or who were using an antidepressant were considered depressive; 18 known cardiovascular risk factors were incorporated in the present study.

Results

At the individual risk factor level, smoking, drinking, living alone, sleep quality, body mass index, waist circumference and diabetes status had differential associations with depression risk according to the gender, age or CVD status of the participants. Most importantly, gender-stratified cumulative risk analysis indicated that similar depression risk was found in both genders with a small number of CVD risk factors (odds ratio (OR)adjusted=1.32; 95% confidence interval (CI): 0.87 to 1.99), but females had a significantly higher depression risk compared with males under high cumulative risk exposure (ORadjusted=2.86; 95% CI: 1.79 to 4.59).

Conclusions

Clarifying the association of numerous CVD risk factors with depression according to gender, age and overall CVD status may be beneficial for risk stratification and the prevention of depression in clinical practice. Moreover, the observed novel evidence of high cumulative risk exposure-mediated gender disparities in depression risk may shed light on the underlying mechanism of females' greater vulnerability to depression.

The effects of proactive approach and integrated medical care on psychological distress in hospitalized patients: A single center experience

PURPOSE

Psychological distress is common among patients with acute diseases and is associated with a poorer prognosis. Early detection and intervention are important for high-risk individuals.

DESIGN AND METHODS

This retrospective study used the five-item Brief Symptom Rating Scale (BSRS-5) to assess psychological distress and evaluate whether proactive intervention may reduce distress levels among hospitalized patients in a single medical center in northern Taiwan.

FINDINGS

Of the patients, 10.7% were found to have varying degrees of emotional distress (BSRS-5 ≥ 6). After providing integrated medical care for patients with psychological distress, the degree of stress decreased significantly (p < 0.001). These results were consistent across subgroups.

PRACTICE IMPLICATIONS

The results highlight that proactive assessment and appropriate interventions may reduce patients' psychological distress during their course of hospitalization.

Association of Retinal Nerve Fiber Layer Thickness, an Index of Neurodegeneration, With Depressive Symptoms Over Time

IMPORTANCE

Whether neurodegeneration contributes to the early pathobiology of late-life depression remains incompletely understood.

OBJECTIVE

To investigate whether lower retinal nerve fiber layer (RNFL) thickness, a marker of neurodegeneration, is associated with the incidence of clinically relevant depressive symptoms and depressive symptoms over time.

DESIGN, SETTING, AND PARTICIPANTS

This is a population-based cohort study from the Netherlands (The Maastricht Study) with baseline examination between 2010 and 2020 and median (IQR) follow-up of 5.0 (3.0-6.0) years. Participants were recruited from the general population. Individuals with type 2 diabetes were oversampled by design. Data analysis was performed from September 2020 to January 2021.

EXPOSURES

RNFL, an index of neurodegeneration, assessed with optical coherence tomography.

MAIN OUTCOMES AND MEASURES

Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9 (continuous score, 0-27) at baseline and over time via annual assessments. The presence of clinically relevant depressive symptoms was defined as a PHQ-9 score of 10 or higher.

RESULTS

We used data from 4934 participants with depressive symptoms over time (mean [SD] age, 59.7 [8.4] years; 2159 women [50.8%]; 870 had type 2 diabetes [20.5%]). Lower RNFL thickness was associated with higher incidence of clinically relevant depressive symptoms (per 1 SD, hazard ratio 1.11; 95% CI, 1.01-1.23) and more depressive symptoms over time (per 1 SD, rate ratio, 1.04; 95% CI, 1.01-1.06), after adjustment for demographic, cardiovascular, and lifestyle factors.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that lower RNFL thickness is associated with higher incidence of clinically relevant depressive symptoms and more depressive symptoms over time. Hence, neurodegeneration may be associated with the early pathobiology of late-life depression.

Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives

Depression is common in older individuals and is associated with high disability and mortality. A major problem is treatment resistance: >50% of older patients do not respond to current antidepressants. Therefore, new effective interventions for prevention and treatment of depression in older individuals need to be developed, which requires a better understanding of the mechanisms underlying depression. The pathophysiology of depression is multifactorial and complex. Microvascular dysfunction may be an early and targetable mechanism in the development of depression, notably depression that initiates in late life (late-onset depression). Late-onset depression commonly co-occurs with other diseases or syndromes that may share a microvascular origin, including apathy, cognitive impairment, dementia, and stroke. Together, these disabilities may all be part of one large phenotype resulting from global cerebral microvascular dysfunction. In this review, we discuss the pathophysiology of microvascular dysfunction-related late-onset depression, summarize recent epidemiological evidence on the association between cerebral microvascular dysfunction and depression, and indicate potential drivers of cerebral microvascular dysfunction. We also propose the hypothesis that depression may be a manifestation of a larger phenotype of cerebral microvascular dysfunction, highlight potential therapeutic targets and interventions, and give directions for future research.

Targeting the renin angiotensin system for the treatment of anxiety and depression

Emotional disorders like anxiety and depression are responsible for considerable morbidity and mortality all over the world. Several antidepressant and anxiolytic medications are available for the treatment of anxiety and depression. However, a significant number of patients either do not respond to these medications or respond inadequately. Hence, there is a need to identify novel targets for the treatment of anxiety and depression. In this review we focus on the renin angiotensin system (RAS) as a potential target for the treatment of these disorders. We review work that has evaluated the effects of various compounds targeting the RAS on anxiety- and depression-like behaviors. Further, we suggest future work that must be carried out to fully exploit the RAS for the treatment of anxiety and depression. The RAS provides an attractive target for both the identification of novel anxiolytic and antidepressant medications and/or for enhancing the efficacy of currently available medications used for the treatment of anxiety and depression.

Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort

While comorbidity between coronary heart disease (CHD) and depression is evident, it is unclear whether the two diseases have shared underlying mechanisms. We performed a range of analyses in 367,703 unrelated middle-aged participants of European ancestry from UK Biobank, a population-based cohort study, to assess whether comorbidity is primarily due to genetic or environmental factors, and to test whether cardiovascular risk factors and CHD are likely to be causally related to depression using Mendelian randomization. We showed family history of heart disease was associated with a 20% increase in depression risk (95% confidence interval [CI] 16-24%, p < 0.0001), but a genetic risk score that is strongly associated with CHD risk was not associated with depression. An increase of 1 standard deviation in the CHD genetic risk score was associated with 71% higher CHD risk, but 1% higher depression risk (95% CI 0-3%; p = 0.11). Mendelian randomization analyses suggested that triglycerides, interleukin-6 (IL-6), and C-reactive protein (CRP) are likely causal risk factors for depression. The odds ratio for depression per standard deviation increase in genetically-predicted triglycerides was 1.18 (95% CI 1.09-1.27; p = 2 × 10-5); per unit increase in genetically-predicted log-transformed IL-6 was 0.74 (95% CI 0.62-0.89; p = 0.0012); and per unit increase in genetically-predicted log-transformed CRP was 1.18 (95% CI 1.07-1.29; p = 0.0009). Our analyses suggest that comorbidity between depression and CHD arises largely from shared environmental factors. IL-6, CRP and triglycerides are likely to be causally linked with depression, so could be targets for treatment and prevention of depression.

[The cognitive-behavioural impact of hypertension]

Arterial hypertension is considered the main modifiable vascular risk factor that causes silent damage to brain vessels. This vascular brain injury could be the common nucleus that justifies the cognitive (cognitive impairment, dementia and Alzheimer's disease) and behavioural symptoms (late-life depression) of target organ damage mediated-hypertension. Incomplete knowledge about the complex pathophysiology that links hypertension with cognitive-behavioural changes is overlooking brain involvement and underestimating cardio and cerebrovascular risk. The confluence of cognitive impairment, depression and arterial hypertension in elderly adults, warns of the need for a comprehensive evaluation to plan treatment, improve prognosis and contribute to reducing the risk of dementia and its incidence.

C-reactive protein in midlife is associated with depressive symptoms two decades later among men with coronary heart disease

Aim: We investigated the relationship between midlife C-reactive protein (CRP) levels in men with coronary heart disease (CHD) and depressive symptoms at old age. CRP levels were measured in a subset of patients with CHD, who previously participated in a secondary prevention trial.Methods: Depressive symptoms were evaluated in survivors of the original cohort 15.0 ± 3 and 19.9 ± 1 years later (T1, n = 463 and T2, n = 314 respectively) using the Geriatric Depression Scale (GDS), 15-item version. Logistic regression was used to estimate ORs and 95%CIs for presence of potentially clinically significant depressive symptoms (GDS ≥5) at T1 and T2.Results: Adjusting for demographic and health-related variables, the OR (95%CI) for GDS ≥5 was 1.23 (0.65-2.33); p = .53 at T1 and 2.36 (1.16-4.83); p = .018 at T2 in the top CRP tertile compared to the others. Similarly, consistently high CRP levels in the top tertile at baseline and 2 years later, were associated with OR of 2.85 (95%CI 1.29-6.30); p = .01 for GDS ≥5 at T2.Conclusions: Presence and persistence of low-grade inflammation in men with CHD during midlife are associated with increased risk of depressive symptoms twenty years later. Among middle aged men with CHD, low-grade inflammation may provide an important added value for prediction of depression in old age.

Antihypertensive treatment and depressive symptoms in Chinese middle-aged and older hypertensive adults: A population-based longitudinal study

OBJECTIVES

Hypertension is a risk factor for depressive disorders. Although the benefits of lowering blood pressure on the subsequent depressive disorders are supported by biological interpretation, the effect of antihypertensive therapies on depressive disorders is not clear. This study aimed to assess whether blood-pressure-lowering treatment have a protective effect on subsequent depressive symptoms in China.

METHODS

We used data from the nationally representative survey, including 2428 hypertensive participants free from depressive symptoms at baseline in 2011 to 2012. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of antihypertensive treatment on the incidence of depressive symptoms in 2011 to 2015.

RESULTS

In the total sample, all the models resulted in nonsignificant results and an estimated 8% reduction in risk (95% CI, 0·76-1·12) in the model adjusted for all covariates for the antihypertensive treatment takers with blood pressure controlled. In the group of urban residents, the antihypertensive treatment takers with blood pressure controlled had lower odds (HR: 0.68; 95% CI, 0·49-0·96) of depressive disorders.

CONCLUSION

The protective effect of the antihypertensive therapies might be relative to not only lowering blood pressure per se but also the management of hypertension. We proposed the early intervention to achieve the long-term protective effect of being antihypertensive and the supply of effective and collaborative care of hypertension and depression.

Comorbid hypertension in patients with major depressive disorder - Results from a European multicenter study

The objective of the present multicenter study was to elucidate relevant associations between major depressive disorder (MDD) and comorbid hypertension that are known for their frequent co-occurrence and interaction with regard to functional disability. Demographic and clinical information of altogether 1410 patients were retrieved cross-sectionally. Consecutively, a comparison of patient characteristics between MDD subjects with and without comorbid hypertension were conducted by descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses. The point prevalence rate for comorbid hypertension was 18.9%. Patients with MDD+comorbid hypertension were significantly older, heavier, more likely to be in a relationship, inpatient and diagnosed with further comorbid chronic somatic diseases including heart disease, diabetes and thyroid dysfunction. In addition, individuals with MDD and comorbid hypertension exhibited a higher score at the Montgomery and Åsberg Depression Rating Scale (MADRS) at onset of the current depressive episode. Melancholic features of depression showed a higher probability. The first line antidepressant treatment did not differ significantly between MDD subjects with versus without comorbid hypertension. Augmentation with pregabalin and combination with one additional antidepressant, however, were more common in the MDD+hypertension group. In conclusion, high blood pressure may influence illness severity and is associated with a distinct psychopathology in MDD patients. Patients with MDD and comorbid hypertension, that seems to be underdiagnosed in MDD patients compared to the general population, are subject to additional somatic diseases in almost 100 percent of the cases and hence, need to be screened and treated accordingly.

Hypertension, socioeconomic status and depressive symptoms in Chinese middle-aged and older adults: Findings from the China health and retirement longitudinal study

BACKGROUND

This study aimed to examine the effect of diagnosed hypertension on depressive symptoms and socioeconomic status (SES) as moderator in the effect in middle-aged and older adults in China.

METHODS

We used data from the nationally representative survey of China Health and Retirement Longitudinal Study, including 6273 participants free from depressive symptoms at baseline in 2011-12. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of baseline diagnosed hypertension status on the subsequent depressive symptoms in 2011-15 with the report of Hazards ratios (HRs).

RESULTS

The diagnosed hypertensive participants were more likely to have depressive symptoms than non-hypertensive peers (HR = 1.12, 95% CI: 1.02-1.23) after adjusted for controlled variables. The effect only occurred in the group of low SES, with rural residency (HR = 1.13, 95% CI: 1.02-1.26), below-average household income (HR = 1.14, 95% CI: 1.02-1.26) and primary school or below educational attainment (HR = 1.12, 95% CI: 1.00-1.25).

LIMITATIONS

Measures of the onset or duration of hypertension were not included, which may modify the estimated effects on depressive symptoms.

CONCLUSIONS

Diagnosed hypertension is a chronic stressor leading to depressive disorders, and the responses to this stressor merely occurred among the low socioeconomic individuals. Our findings underscored the importance of examining the connection between mental and physical health in the context of aging and shed lights on the action to developing strategies for detection and management of hypertension that could cause psychological stress, which may contribute to fighting against depressive symptoms, especially in the low SES population.

Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study

Background

Depressive symptomatology may act as a barrier to enhance physical activity. This phenomenon is predominantly found in patients with an established cardiovascular disease (CVD) and in female patients. This cross-sectional study investigated (1) the association between symptoms of depression and physical inactivity, and (2) whether this association is different between primary and secondary prevention patients, and between men and women.

Methods

The study design concerns a secondary analysis of baseline data from a randomized clinical trial, including primary and secondary prevention patients (n = 2184; mean age 71.6 ± 8.94), from 34 general practitioner panels. The Rapid Assessment of Physical Activity questionnaire (RAPA) was used to measure patient reported activity levels. Symptoms of depression were determined using the Patient Health Questionnaire (PHQ-9). Multilevel linear regression analysis was used to explore the association between symptoms of depression and physical activity while adjusting for confounders. Gender and whether or not having a CVD were considered as potential effect modifiers for the association between symptoms of depression and inactivity.

Results

Symptoms of depression were associated with lower levels of physical activity. This association was neither different for men and women nor for primary and secondary prevention patients.

Conclusion

In primary care patients’ symptoms of depression were associated with physical inactivity. This association was not modified by gender or the presence of a CVD. Future research should focus on lifestyle interventions aiming at the increase of physical activity levels, while emphasizing on improving symptoms of depression in men, women, and patients both with and without a history of CVD.

The association between mean platelet volume levels and poststroke depression

OBJECTIVE

High levels of mean platelet volume (MPV) had been found in depression subjects. We sought to examine the relationship between MPV and poststroke depression (PSD).

METHODS

One hundred and eighty-five patients with acute ischemic stroke were enrolled in our study. Peripheral venous blood samples were drawn at admission and MPV levels were measured by the automated hematology analyzer. Patients with a HAMD-17 score >7 were diagnosed as having PSD.

RESULTS

We found that 60 patients (32.4%) developed PSD, the MPV levels in PSD patients were significantly higher (9.3 ± 1.8 fl) compared to non-PSD patients (8.5 ± 1.6 fl). High MPV levels (≥9.1 fl) were independently correlated with PSD (OR 2.762, 95% CI 1.138-6.702, p = 0.025).

CONCLUSIONS

Patients with higher levels of MPV at admission were correlated with the development of PSD at 1 month after stroke and might be a predictor of its presence.

Relationship between estimated cardiovascular disease risk and insulin resistance in a black African population living with HIV: a cross-sectional study from Cameroon

OBJECTIVES

Cardiovascular disease (CVD) and metabolic diseases are growing concerns among patients with HIV infection as a consequence of the improving survival of this population. We aimed to assess the relationship between CVD risk and insulin resistance in a group of black African individuals with HIV infection.

METHODS

This cross-sectional study involved patients with HIV infection aged 30-74 years and followed up at the Yaoundé Central Hospital, Cameroon. Absolute CVD risk was calculated using the Framingham and the DAD CVD risk equations while the HOMA-IR index was used to assess insulin resistance (index ≥2.1).

RESULTS

A total of 452 patients (361 women; 80%) were screened. The mean age was 44.4 years and most of the respondents were on antiretroviral therapy (88.5%). The median 5-year cardiovascular risk was 0.7% (25th-75th percentiles: 0.2-2.0) and 0.6% (0.3-1.3) according to the Framingham and DAD equations respectively. Of all participants, 47.3% were insulin resistant. The Framingham equation derived absolute CVD risk was significantly associated with insulin resistance; while no linear association was found using the DAD equation.

CONCLUSION

The relationship between cardiovascular risk and insulin resistance in black African patients with HIV infection seems to depend on the cardiovascular risk equation used.