Risk of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities: Prospective Analysis from the English Longitudinal Study of Ageing

Abstract

High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study was to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item binary Centre for Epidemiologic Studies–Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Multiple imputation by chained equations was performed to account for missing data. Covariates included age, sex, education, income, smoking status, physical activity, alcohol consumption, and cardiovascular comorbidity. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) no or low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) high depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.29 (95% CI 0.63, 2.64) for those with high depressive symptoms only, 3.88 (95% CI 2.77, 5.44) for those with cardiometabolic abnormalities only, and 5.56 (95% CI 3.45, 8.94) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic, lifestyle and clinical variables. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities are at a particularly increased risk of type 2 diabetes.

Risk of dementia associated with cardiometabolic abnormalities and depressive symptoms: a longitudinal cohort study using the English longitudinal study of ageing

“…19,25 The first group had no or low depressive symptoms and no cardiometabolic abnormalities. 19,25 The first group had no or low depressive symptoms and no cardiometabolic abnormalities.…”

“…18,19,25 Central obesity was defined as having waist circumference of greater than or equal to 94 cm for European men and greater than or equal to 80 cm for European women. These risk factors were chosen as they have been used in previous work to identify cardiometabolic abnormalities.…”

“…Hyperglycaemia was defined as having raised fasting plasma glucose (FPG) of greater than or equal to 5.6 mmol/L and/or having a previous diagnosis of type 2 diabetes. 19 6 Finally, systemic inflammation was determined as having CRP levels of greater than 3 mg/L, according to the American Heart Association and the Center for Disease Control.…”

“…Participants were dichotomized into those with "no or low" (CES-D < 4) and those with "high" (CES-D ≥ 4) depressive symptomatology, in line with previous ELSA studies. 19,25…”

“…16,17 This comorbidity is associated with lifestyle and health-related risk factors (eg, poor self-care) for cardiovascular and metabolic diseases. 18,19 These cardiovascular and metabolic diseases have been shown to be risk factors for development of future dementia. 20 Furthermore, work shows that co-occurring cardiometabolic abnormalities and depressive symptoms are risk factors for cognitive decline.…”