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

Research Article

Bhautesh Dinesh Jani¹  Sarah JE Barry²  Naveed Sattar³  Frances S Mair⁴  Jonathan Cavanagh⁵  Geoff Der⁶ 

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

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

DOI  :  10.1186/1471-2261-14-139

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

来源: Springer

【 摘 要 】

BackgroundDepression 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.MethodsWe 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.ResultsSBP 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.ConclusionIn 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.

【 授权许可】

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© Jani et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.