Depression symptoms and the progression of carotid intima-media thickness: a 5-year follow-up study

Abstract

ObjectiveOnly a few studies have investigated the changes in carotid intima-media thickness (IMT) over time, and uncertainties remain on the underlying mechanisms linking depression and subclinical atherosclerosis. We carried out a prospective cohort study to evaluate whether depression is associated with changes in carotid IMT in subjects with cardiac risk factors but free from coronary heart disease (CHD), and to what extent the atherogenicity of depression can be explained by inflammatory markers and autonomic nervous system dysfunction. MethodsDuring baseline and follow-up visits: all participants were asked to provide blood samples and compile a structured questionnaire; trained physicians assessed depression symptoms using Beck Depression Inventory (BDI); altered cardiac autonomic tone was measured using time-domain components of heart rate variability in 24 h Holter recordings; measurements of carotid IMT were carried out using B-mode ultrasound image acquisition. Logistic and linear regression analyses were used to adjust for potential confounders and explore potential mediators. ResultsA total of 381 subjects completed the 5-year follow-up. The mean carotid IMT significantly increased in all subjects but the amount of increase was significantly larger among subjects with depression symptoms: mean IMT increased by 0.16 ± 0.14 mm; 0.31 ± 0.28 mm and 0.61 ± 0.54 mm among the subjects with no, mild and moderate/severe depression, respectively (all p < 0.01). The association between moderate/severe depression and IMT increase remained highly significant even after controlling for all the variables considered, however when both IL-6 and CRP were included in multivariate models the regression coefficient decreased by 42.3%. Some of the inflammation markers and autonomic nervous system dysfunction were also independently correlated with carotid IMT increase. ConclusionDepression symptoms are independently associated with an accelerated progression of carotid IMT in subjects with CHD risk factors, and inflammation may substantially modulate the association between depression and carotid IMT progression.

Accumulation of Depressive Symptoms and Carotid Intima-Media Thickness: the Cardiovascular Risk in Young Finns Study

“…To continue, we should not exclude a role of depression for atherosclerosis in the certain context (i.e., the effect of age). The considerable amount of studies have found an association between depression and atherosclerosis in older populations (50 years of age and older) (9,10,12,(19)(20)(21)43). Although there was no relation between depressive symptoms and carotid IMT in older participants (aged 39-45 years) in this study, it is possible that atherosclerosis may be detectable relatively late in life.…”

“…Both positive relationships (9)(10)(11)(12) and null findings (13)(14)(15)(16)(17) have been documented. With few exceptions (18), the general pattern of findings has been that depressive symptoms are positively associated with increased IMT in people over the age of 50 (9,10,(19)(20)(21); whereas no association was found for younger participants (22,23) or a combination of younger and older people (13,14).…”

The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis

“…Pizzi et al carried out a five-year follow-up study on depressive symptoms and the progression of IMT, and demonstrated that IMT significantly increased among subjects with depressive symptoms. 89 In a longitudinal study of the relations among depressive symptoms and PWV, Satoh et al showed that the changes in the PWV values correlated significantly and positively with depressive symptoms after three years of follow-up. 68 Wagner et al reported that subjects who had a positive lifetime history of depression showed significantly and clinically meaningful lower FMD than never depressed subjects.…”

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

“…A total of three logistic regression models were built for PAS3 (type of COS, pregnancy implantation on the scar vs in the niche or normal and sac position below vs above the uterine midline) and four for composite adverse surgical outcome (PAS3 vs lower stages, type of COS, pregnancy implantation on the scar vs in the niche or normal and sac position below vs above the uterine midline). Moreover, to reduce potential overfitting due to the limited number of women experiencing an adverse surgical outcome ( n = 22), the number of covariates for this outcome was limited to three in every phase of model fitting. The goodness‐of‐fit was evaluated using the Hosmer–Lemeshow test and the predictive power was assessed using C‐statistics (area under the receiver‐operating‐characteristics curve (AUC)).…”