Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA–KORA Augsburg Cohort Study 1984–1998

Abstract

Objective: To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD). Design: A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women. Subjects: A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI X30 kg/m 2 ). Measurements: Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features. Results: The main effect of obesity to predict a future CHD (hazard ratio, HR ¼ 1.38, 95% CI 1.03-1.84; P ¼ 0.031) and the interaction term of obesity by depression (HR ¼ 1.73, 95% CI 0.98-3.05; P ¼ 0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR ¼ 1.17, 95% CI 0.76-1.80; P ¼ 0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR ¼ 2.32, 95% CI 1.45-3.72, P40.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P ¼ 0.158). Conclusions: Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.

Research aimed at improving both mood and weight (RAINBOW) in primary care: A type 1 hybrid design randomized controlled trial

“…In turn, this could help prevent long-term complications of these conditions, such as type 2 diabetes mellitus, cardiovascular disease, and dementia. 3,15,17,98 If successful, this study will offer the potential to change how obese and depressed adults are treated using an integrated multicondition collaborative care model in primary care.…”

“…12–14 Not only are obesity and depression associated with the same health complications (e.g., type 2 diabetes mellitus and cardiovascular disease), but their coexistence exerts synergistic adverse effects on treatment adherence and response for both conditions. 15–17 …”

Obesity: Is it a Mental Disorder?

“…133,134 The exact causes for the comorbidity of obesity and non-eating-related mental disorders remain unknown. In particular, current data suggest that the presence of psychiatric symptoms, particularly depression, increases the likelihood of developing obesity [46][47][48] and obesity-related medical comorbidities (e.g., cardiovascular disease, diabetes, metabolic syndrome) [142][143][144] and vice versa. For example, obesity shares a number of symptomatic features in common with psychiatric disorders including increased appetite, decreased activity levels, and sleep disturbance.…”

Position paper on the importance of psychosocial factors in cardiology: Update 2013

“…Obesity plays an important role in the metabolic syndrome (abdominal obesity, high blood pressure, dyslipidaemia and insulin resistance). As BMI increases, so does the risk for CHD and myocardial infarction, whereby comorbid depression has a synergistic effect [67]. Nonetheless, patients with chronic CHD or heart failure with a moderately increased BMI (BMI <30) have been shown to have a better prognosis [68].…”