Depressive Symptoms and Subclinical Markers of Cardiovascular Disease in Adolescents

Abstract

Purpose-To examine the association between depressive symptoms and subclinical markers of cardiovascular disease (CVD), specifically arterial stiffness, as indexed by pulse wave velocity (PWV), and carotid artery intima thickening (IMT), in a sample of healthy adolescents, and to explore adolescent hostility as a potential moderator of depression on subclinical markers of CVD.Methods-One hundred and fifty-seven (n = 157) black and white adolescents between the ages of 16-21 completed a follow-up study of psychosocial stress and cardiovascular risk factors that included measures of PWV and carotid IMT. Psychosocial measures included the Center for Epidemiologic Studies Depression Scale (CES-D; divided into tertiles), and the Cook-Medley Hostility Inventory subscales. Linear regression models controlled for sociodemographic variables, health behaviors, blood pressure, body mass index, and heart rate. Results-Resultsshow that more severe depressive symptoms were associated with higher levels of PWV (B = 0.17, R 2 = 0.30, ΔR 2 = 0.03, CI = 2.2 -47.0, p = .03) but not with higher IMT. Adolescent depression remained a significant predictor of PWV when controlling for adolescent hostility; hostility did not moderate the relationship between adolescent depression and PWV.Conclusions-Depression may be important in the development of arterial stiffness in adolescence. Further research is needed to delineate the relationship in adolescence and young adulthood between depressive symptoms and the pathogenesis of CVD. Keywords depression; adolescents; hostility; pulse wave velocity; cardiovascular disease Depression is a debilitating and burdensome mental health condition, due to its high prevalence, chronic nature, and associated physical health conditions that contribute to lost productivity and high costs of medical care 1-2 . The relationship between depression and chronic health conditions, such as heart disease, asthma, diabetes, and arthritis, has been highlighted for its public health significance, as depression often develops earlier in the lifespan than do most progressive health conditions 3 . While the association between depression and chronic physical illness has been firmly documented in the empirical literature, the mechanisms accounting for the association remain unclear 4 . Physiological mechanisms, shared etiological factors, and poor health behaviors have been proposed to account for this relationship 5 .Correspondence should be sent to Dr. Dietz, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Bellefield Towers Room 309, Pittsburgh, PA 15213; dietzlj@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the ...

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

“…In a cross-sectional study of 157 black and white 16-to 21-year-olds, depressive symptoms were not correlated with right and left common CIMT. 40 However, higher levels of depressive symptoms were associated with higher pulse-wave velocity, indicative of increased vascular stiffness, independent of covariates (including body mass index, systolic blood pressure, and social class; lipid profiles were not measured). These studies together indicate a plausibly adverse but as yet inconsistent relationship between depressive symptoms and CIMT among adolescents and young adults.…”

Severity of Depression and Anxiety Symptoms is Associated with Increased Arterial Stiffness in Depressive Disorder Patients Undergoing Psychiatric Treatment

“…In a previous study, the severity and duration of depressive symptoms were positively correlated with increase in AIx 5 . In another study, a positive correlation between symptom severity of depression and PWV was detected in adolescent patients with major depressive disorder (age between 16-21 years, n=157) 18 . It can be argued that whether antidepressant treatment and/ or decrease in depressive symptom severity or drug specific effects have influences on arterial stiffness or not as measured by PWV and AIx.…”

“…Assessment of arterial stiffness parameters is a non-invasive method of subclinical CVD and arterial aging 18 . Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness 19 .…”

Early Identification of Cardiovascular Risk Factors in Adolescents and Follow-Up Intervention Strategies

“…A study on depressive symptoms and subclinical markers of cardiovascular disease in adolescents was conducted by Dietz and Matthews (2011) with 157 black and white adolescents 16-21 years of age. The study was of psychosocial stress and cardiovascular risk factors with measurements of arterial stiffness as tested by pulse wave velocity (PWV) and intima media thickening (IMT).…”

“…The study was of psychosocial stress and cardiovascular risk factors with measurements of arterial stiffness as tested by pulse wave velocity (PWV) and intima media thickening (IMT). The Center for Epidemiological Studies Depressive Scale and the Cook-Medley Hostility Inventory subscales were used and described (Dietz & Matthews, 2011). Linear regression controlled for socio-demographic variables, health behaviours, blood pressure, BMI and heart rate.…”