Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes: a cross sectional study

Abstract

BackgroundDepression, metabolic disturbances and inflammation have been linked to cardiovascular disease and mortality. Low levels of high-density lipoprotein cholesterol (HDL-cholesterol), a known marker of cardiovascular risk, have been observed in patients with major depression in psychiatric populations. Our main aim was to explore associations between depression, antidepressants, and metabolic and inflammatory variables in patients with type 1 diabetes (T1D). A secondary aim was to explore variables associated with HDL-cholesterol.MethodsCross-sectional design. T1D patients (n = 292, men 55%, age18–59 years, diabetes duration ≥1 year) were consecutively recruited from one specialist diabetes clinic. Depression was defined as ≥8 points for Hospital Anxiety and Depression Scale-Depression sub scale. Blood samples, anthropometrics, blood pressure, and data regarding medication and life style were collected from electronic health records. Non-parametric tests, multiple logistic and linear regression analyses were performed.ResultsThe depression prevalence was 10 and 8% used antidepressants. Median (q1, q3) HDL-cholesterol (mmol/l) was for the depressed 1.3 (1.2, 1.5) and for the non-depressed 1.6 (1.3, 1.8), p = 0.001. HDL-cholesterol levels (per mmol/l) were negatively associated with depression (Adjusted odds ratio (AOR) 0.2, p = 0.007), and the use of antidepressants was positively associated with depression (AOR 8.1, p < 0.001). No other metabolic or inflammatory variables, or life style factors, were associated with depression when adjusted for antidepressants. Abdominal obesity was associated with antidepressants in women (AOR 4.6, p = 0.029). Decreasing HDL-cholesterol levels were associated with increasing triglyceride levels (p < 0.001), increasing high-sensitive C-reactive protein (hs-CRP) levels (p = 0.021), younger age (p < 0.001), male sex (p < 0.001), and depression (p = 0.045).ConclusionsLower HDL-cholesterol levels, known predictors of cardiovascular disease, were associated with depression in patients with T1D. The use of antidepressants was associated with abdominal obesity in women. Depression, low-grade inflammation measured as hs-CRP, higher triglycerides, male sex, and lower age were independently associated with lower HDL-cholesterol levels.

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“…In addition, high serum ApoB level is also negatively correlated with delayed memory decline owing to its relation to the dysfunctions of lipid peroxidation, malondialdehyde (MDA) and immune system [47] . The ratios of HDL-C/LDL-C and APOB/APOA1 are signi cantly correlated with depression and cardiovascular diseases [48][49][50] . Abundant serum albumin which is related to cardiovascular disease [51] is signi cantly decreased in depressive patients [52] .…”

Higher levels of the soluble receptor for advanced glycation end products and lower levels of the extracellular newly identified receptor for advanced glycation end products were associated with lipid-lowering drugs in patients with type 1 diabetes: a comparative cross-sectional study

“…The study has a cross sectional design, and is one of several studies addressing metabolic and inflammatory disturbances in a cohort of patients with T1D [24][25][26][27][28][29][30]. For inclusion and exclusion criteria, number of included and excluded patients, and missing variables, see Fig.…”

“…The catchment population was 125,000. The patients who attended the clinic every six months for regular follow up visits were consecutively recruited by specialist diabetes physicians or diabetes nurses during a nine-month period, 25 March 2009 to 28 December 2009 [24][25][26][28][29][30]. Blood samples, anthropometrics, and blood pressure (BP) were collected, and supplemented with data from electronic health records.…”

“…Self-reported depression was assessed by the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) which consists of 7 statements, with 4 response alternatives from 0 to 3. Depression was defined as HADS-D ≥ 8 points as in previous research in these patients [24,26,28,32].…”

“…Indications for LLD were total cholesterol > 4.5 mmol/L (> 1.74 mg/dL) and/or LDL-cholesterol > 2.5 mmol/L (> 97 mg/dL) or present cardiovascular complications according to the Swedish national guidelines in 2009 [33]. The use of LLD was dichotomized into users and non-users as in previous research in these patients [25,26].…”