Revisiting the J shaped curve, exploring the association between cardiovascular risk factors and concurrent depressive symptoms in patients with cardiometabolic disease: Findings from a large cross-sectional study

BMC Cardiovascular Disorders

Frances S Mair²  Naveed Sattar³  Geoff Der⁵  Sarah JE Barry⁶  Jonathan Cavanagh¹  Bhautesh Dinesh Jani⁴ 

[1] Professor of Psychiatry, Mental Health and Wellbeing, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Neurology Block, Southern General Hospital, Glasgow G51 4TF, UK;Professor of Primary Care Research, General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G112 9LX, UK;Professor of Metabolic Medicine, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK;CSO Clinical Fellow, General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 9LX, UK;Statistician, MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8RZ, UK;Consultant Biostatistician, Robertson Centre for Biostatistics, Institute of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK

关键词: Coronary heart disease;    Stroke;    Diabetes;    HbA1C;    Total cholesterol;    Body mass index;    Blood pressure;    Depression;    J-curve;    Cardiovascular risk factors;   

Others  :  1088423
DOI  :  10.1186/1471-2261-14-139

 received in 2014-07-24, accepted in 2014-10-03,  发布年份 2014

【 摘 要 】

Background

Depression is common in patients with cardiometabolic diseases but little is known about the relationship, if any, between cardiovascular risk factor values and depressive symptoms in patients with these conditions. The objective of this paper is to study the association between cardiovascular risk factors and concurrent depressive symptoms in patients with three common cardiometabolic conditions: coronary heart disease (CHD), stroke and diabetes.

Methods

We retrospectively reviewed primary care data for N = 35537 with 1 of the above 3 conditions who underwent depression screening using the depressive subscale of hospital anxiety and depression score (HADS-D). We reviewed 4 cardiometabolic risk factors (Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], BMI and total cholesterol) recorded concurrently in all patients and HbA1c in patients with diabetes (n = 18453). We analysed the association between individual risk factor value and a positive HADS-D screening result (>7) using logistic regression.

Results

SBP and BMI were noted to have a non-linear “J-shaped” relationship with the probability of having a positive HADS-D and observed nadirs (levels with the lowest probability) of 148 mm Hg and 30.70 kg/m2, respectively. Total cholesterol and DBP found to have a weaker curvilinear association with concurrent depression symptoms and nadirs of 3.60 mmol/l and 74 mmHg. Among patients with Diabetes, HbA1c was also found to have a “J-shaped” relationship with probability of having a positive HADS-D with an observed nadir of 7.06% DCCT. The above relationships remain significant after adjusting for age, sex, socio-economic status and number of co-morbid conditions.

Conclusion

In patients with cardiometabolic disease, cardiovascular risk factor values at both extremes were associated with higher positive depression screening after adjusting for confounders. These findings have potentially important implications for clinical practice in relation to both risk stratification for depression and approaches to secondary prevention in individuals with cardiometabolic disease and merit further investigation to determine the nature and direction of the observed association.

Please see related article: http://www.biomedcentral.com/1741-7015/12/199 webcite.

【 授权许可】

   
2014 Jani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Egede LE: Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry 2007, 29:409-416.
• [2]Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007, 370:851-858.
• [3]Ali S, Stone MA, Peters JL, Davies MJ, Khunti K: The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006, 23:1165-1173.
• [4]Hadidi N, Treat-Jacobson DJ, Lindquist R: Poststroke depression and functional outcome: a critical review of literature. Hear Lung 2009, 38:151-162.
• [5]Whooley MA, De JP, Vittinghoff E, Otte C, Moos R, Carney RM, Ali S, Dowray S, Na B, Feldman MD, Schiller NB, Browner WS: Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008, 300:2379-2388.
• [6]Larsen KK, Christensen B, Sondergaard J, Vestergaard M: Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction: A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions. PLoS One 2013, 8:e74393.
• [7]Katon WJ, Rutter C, Simon G, Lin EH, Ludman E, Ciechanowski P, Kinder L, Young B, Von KM: The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005, 28:2668-2672.
• [8]Pozuelo L, Tesar G, Zhang J, Penn M, Franco K, Jiang W: Depression and heart disease: what do we know, and where are we headed? Cleve Clin J Med 2009, 76:59-70.
• [9]Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES: Depression and coronary heart disease: recommendations for screening, referral, and treatment. Circulation 2008, 118:1768-1775.
• [10]Ontario HQ: Screening and management of depression for adults with chronic diseases: an evidence-based analysis. Ont Health Technol Assess Ser 2013, 13:1-45.
• [11]Thombs BD, Roseman M, Coyne JC, de Jonge P, Delisle VC, Arthurs E, Levis B, Ziegelstein RC: Does Evidence Support the American Heart Association’s Recommendation to Screen Patients for Depression in Cardiovascular Care? An Updated Systematic Review. PLoS One 2013, 8:e52654.
• [12]Smolderen KG, Buchanan DM, Amin AA, Gosch K, Nugent K, Riggs L, Seavey G, Spertus JA: Real-world lessons from the implementation of a depression screening protocol in acute myocardial infarction patients: implications for the American Heart Association depression screening advisory. Circ Qual Outcomes 2011, 4:283-292.
• [13]Burton C, Simpson C, Anderson N: Diagnosis and treatment of depression following routine screening in patients with coronary heart disease or diabetes: a database cohort study. Psychol Med 2013, 43:529-537.
• [14]Jani BD, Purves D, Barry S, Cavanagh J, McLean G, Mair FS: Challenges and Implications of Routine Depression Screening for Depression in Chronic Disease and Multimorbidity: A Cross Sectional Study. PLoS One 2013, 8:e74610.
• [15]NICE: Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. 2009.
• [16]Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, Demyttenaere K, Gasquet I, Haro JM, Karam E, Kessler RC, Levinson D, Medina Mora ME, Oakley Browne MA, Ormel J, Villa JP, Uda H, Von Korff M: Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes (Lond) 2008, 32:192-200.
• [17]De Wit L, Luppino F, van Straten A, Penninx B, Zitman F, Cuijpers P: Depression and obesity: A meta-analysis of community-based studies. Psychiatry Res 2010, 178:230-235.
• [18]Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG: Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010, 67:220-229.
• [19]Meng L, Chen D, Yang Y, Zheng Y, Hui R: Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens 2012, 30:842-851.
• [20]Ancelin ML, Carrire I, Boulenger JP, Malafosse A, Stewart R, Cristol JP, Ritchie K, Chaudieu I, Dupuy AM: Gender and genotype modulation of the association between lipid levels and depressive symptomatology in community-dwelling elderly (The ESPRIT Study). Biol Psychiatry 2010, 68:125-132.
• [21]Hamer M, Batty GD, Kivimaki M: Haemoglobin A1c, fasting glucose and future risk of elevated depressive symptoms over 2 years of follow-up in the English Longitudinal Study of Ageing. Psychol Med 2011, 41:1889-1896.
• [22]Pater C: The Blood Pressure “Uncertainty Range” - a pragmatic approach to overcome current diagnostic uncertainties (II). Curr Control Trials Cardiovasc Med 2005, 6:5. BioMed Central Full Text
• [23]Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense H-W, Joffres M, Kastarinen M, Poulter N, Primatesta P, Rodríguez-Artalejo F, Stegmayr B, Thamm M, Tuomilehto J, Vanuzzo D, Vescio F: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003, 289:2363-2369.
• [24]Penman AD, Johnson WD: The changing shape of the body mass index distribution curve in the population: implications for public health policy to reduce the prevalence of adult obesity. Prev Chronic Dis 2006, 3:A74.
• [25]Thompson R, O’Regan C, Morant S, Phillips B, Ong S: Measurement of baseline total cholesterol: new data from The Health Improvement Network (THIN) database. Prim Care Cardiovasc J 2008, 1:107.
• [26]Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD: Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 2010, 375:481-489.
• [27]NICE: Depression in Adults (update). 2009.
• [28]Scottish Index of Multiple Deprivation (SIMD) http://www.scotland.gov.uk/Topics/Statistics/SIMD webcite
• [29]Team RC: R Core Team (2012). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2012. ISBN 3-900051-07-0. http://www.R-project.org/ webcite
• [30]Barrett-Connor E, Palinkas LA: Low blood pressure and depression in older men: a population based study. BMJ 1994, 308:446-449.
• [31]Stroup-Benham CA, Markides KS, Black SA, Goodwin JS: Relationship between low blood pressure and depressive symptomatology in older people. J Am Geriatr Soc 2000, 48:250-255.
• [32]Pilgrim JA, Stansfeld S, Marmot M: Low blood pressure, low mood? BMJ 1992, 304:75-78.
• [33]Niu K, Hozawa A, Awata S, Guo H, Kuriyama S, Seki T, Ohmori-Matsuda K, Nakaya N, Ebihara S, Wang Y, Tsuji I, Nagatomi R: Home blood pressure is associated with depressive symptoms in an elderly population aged 70 years and over: a population-based, cross-sectional analysis. Hypertens Res 2008, 31:409-416.
• [34]Kim B-S, Bae JN, Cho MJ: Depressive symptoms in elderly adults with hypotension: different associations with positive and negative affect. J Affect Disord 2010, 127:359-364.
• [35]Jorm AF: Association of hypotension with positive and negative affect and depressive symptoms in the elderly. Br J Psychiatry 2001, 178:553-555.
• [36]Morgan RE, Palinkas LA, Barrett-Connor EL, Wingard DL: Plasma cholesterol and depressive symptoms in older men. Lancet 1993, 341:75-79.
• [37]Steegmans PH, Hoes AW, Bak AA, van der Does E, Grobbee DE: Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels. Psychosom Med 2000, 62:205-211.
• [38]Kivimaki M, Tabak AG, Batty GD, Singh-Manoux A, Jokela M, Akbaraly TN, Witte DR, Brunner EJ, Marmot MG, Lawlor DA: Hyperglycemia, Type 2 Diabetes, and Depressive Symptoms: The British Whitehall II study. Diabetes Care 2009, 32:1867-1869.
• [39]Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP: What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TI. Circulation 2010, 122:2142-2151.
• [40]Cushman WC, Evans GW, Byington RP, Goff DC, Grimm RH, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F: Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010, 362:1575-1585.
• [41]Messerli FH, Panjrath GS: The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol 2009, 54:1827-1834.
• [42]Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F: Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 2006, 368:666-678.
• [43]Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH, Probstfield JL, Simons-Morton DG, Friedewald WT: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545-2559.
• [44]Ghadir MR, Riahin AA, Havaspour A, Nooranipour M, Habibinejad AA: The relationship between lipid profile and severity of liver damage in cirrhotic patients. Hepat Mon 2010, 10:285-288.
• [45]Marini A, Carulli G, Azzarà A, Grassi B, Ambrogi F: Serum cholesterol and triglycerides in hematological malignancies. Acta Haematol 1989, 81:75-79.
• [46]Kovesdy CP, Anderson JE, Kalantar-Zadeh K: Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: effects of case mix and the malnutrition-inflammation-cachexia syndrome. J Am Soc Nephrol 2007, 18:304-311.
• [47]O’Neil A, Sanna L, Redlich C, Sanderson K, Jacka F, Williams LJ, Pasco JA, Berk M: The impact of statins on psychological wellbeing: a systematic review and meta-analysis. BMC Med 2012, 10:154. BioMed Central Full Text
• [48]Macedo AF, Taylor FC, Casas JP, Adler A, Prieto-Merino D, Ebrahim S: Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. BMC Med 2014, 12:51. BioMed Central Full Text
• [49]Zureik M, Courbon D, Ducimetière P: Serum cholesterol concentration and death from suicide in men: Paris prospective study I. BMJ 1996, 313:649-651.
• [50]Olson MB, Kelsey SF, Matthews KA, Bairey Merz CN, Eteiba W, McGorray SP, Cornell CE, Vido DA, Muldoon MF: Lipid-lowering medication use and aggression scores in women: a report from the NHLBI-sponsored WISE study. J Womens Health (Larchmt) 2008, 17:187-194.
• [51]Sullivan LE, Fiellin DA, O’Connor PG: The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med 2005, 118:330-341.
• [52]Van der Meer RM, Willemsen MC, Smit F, Cuijpers P: Smoking cessation interventions for smokers with current or past depression. Cochrane Database Syst Rev 2013, 8:CD006102.
• [53]Chaiton MO, Cohen JE, O’Loughlin J, Rehm J: A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health 2009, 9:356. BioMed Central Full Text
• [54]Blumenthal JA, Babyak MA, Carney RM, Huber M, Saab PG, Burg MM, Sheps D, Powell L, Taylor CB, Kaufmann PG: Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial. Med Sci Sports Exerc 2004, 36:746-755.
• [55]Karasz A, Dowrick C, Byng R, Buszewicz M, Ferri L, Olde Hartman TC, Van DS, van Weel-Baumgarten E, Reeve J: What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes. Br J Gen Pract 2012, 62:e55-e63.
• [56]Coventry PA, Hays R, Dickens C, Bundy C, Garrett C, Cherrington A, Chew-Graham C: Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Fam Pract 2011, 12:10. BioMed Central Full Text
• [57]Haddad M, Walters P, Phillips R, Tsakok J, Williams P, Mann A, Tylee A: Detecting Depression in Patients with Coronary Heart Disease: A Diagnostic Evaluation of the PHQ-9 and HADS-D in Primary Care, Findings From the UPBEAT-UK Study. PLoS One 2013, 8:e78493.
• [58]Meader N, Mitchell AJ, Chew-Graham C, Goldberg D, Rizzo M, Bird V, Kessler D, Packham J, Haddad M, Pilling S: Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies. Br J Gen Pract 2011, 61:e808-e820.