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Depressive symptom clusters are differentially associated with atherosclerotic disease

Published online by Cambridge University Press:  10 December 2010

B. A. A. Bus ,
R. M. Marijnissen ,
S. Holewijn ,
B. Franke ,
N. Purandare ,
J. de Graaf ,
M. den Heijer ,
J. K. Buitelaar  and
R. C. Oude Voshaar
B. A. A. Bus*
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
R. M. Marijnissen
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Old Age Psychiatry, De Gelderse Roos, Arnhem, The Netherlands
S. Holewijn
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
B. Franke
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
N. Purandare
Affiliation:
Psychiatry Research Group, School of Community-Based Medicine, University of Manchester, Manchester, UK
J. de Graaf
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
M. den Heijer
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
J. K. Buitelaar
Affiliation:
Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
R. C. Oude Voshaar
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Psychiatry Research Group, School of Community-Based Medicine, University of Manchester, Manchester, UK University Centre of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
*
*Address for correspondence: B. A. A. Bus, M.D., Department of Psychiatry, Radboud University Nijmegen (RUN) Medical Centre, Reinier Postlaan 10, 6525GC Nijmegen, The Netherlands. (Email: [email protected])
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Abstract

Background

Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample.

Method

In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50–70 years and free of stroke and dementia, we measured the intima–media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters.

Results

We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD.

Conclusions

The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.

Keywords

Agedatherosclerosiscognitive-affectivedepressionelderlyfactor analysisintima–media thickness (IMT)somatic-affective
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1419 - 1428
Copyright
Copyright © Cambridge University Press 2010

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References

Alexopoulos, GS (2005). Depression in the elderly. Lancet 365, 1961–1970.CrossRefGoogle ScholarPubMed
Barefoot, JC, Helms, MJ, Mark, DB, Blumenthal, JA, Califf, RM, Haney, TL, O'Connor, CM, Siegler, IC, Williams, RB (1996). Depression and long-term mortality risk in patients with coronary artery disease. American Journal of Cardiology 78, 613–617.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA (1984). Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology 40, 1365–1367.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Bots, ML, Hoes, AW, Koudstaal, PJ, Hofman, A, Grobbee, DE (1997). Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 96, 1432–1437.CrossRefGoogle ScholarPubMed
Bots, ML, Hofman, A, de Jong, PT, Grobbee, DE (1996). Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study. Annals of Epidemiology 6, 147–153.CrossRefGoogle ScholarPubMed
Carney, RM, Freedland, KE (2009 a). Depression and heart rate variability in patients with coronary heart disease. Cleveland Clinical Journal of Medicine 76 (Suppl. 2), S13–S17.CrossRefGoogle ScholarPubMed
Carney, RM, Freedland, KE (2009 b). Treatment-resistant depression and mortality after acute coronary syndrome. American Journal of Psychiatry 166, 410–417.CrossRefGoogle ScholarPubMed
Carney, RM, Rich, MW, Freedland, KE, Saini, J, teVelde, A, Simeone, C, Clark, K (1988). Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosomatic Medicine 50, 627–633.CrossRefGoogle ScholarPubMed
Chen, CS, Chen, CC, Kuo, YT, Chiang, IC, Ko, CH, Lin, HF (2006). Carotid intima-media thickness in late-onset major depressive disorder. International Journal of Geriatric Psychiatry 21, 36–42.CrossRefGoogle ScholarPubMed
Costello, AB, Osborne, JW (2009). Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Practical Assessment, Research and Evaluation 10, 1–9.Google Scholar
Davidson, KW, Burg, MM, Kronish, IM, Shimbo, D, Dettenborn, L, Mehran, R, Vorchheimer, D, Clemow, L, Schwartz, JE, Lesperance, F, Rieckmann, N (2010). Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Archives of General Psychiatry 67, 480–488.CrossRefGoogle ScholarPubMed
de Jonge, P (2009). The importance of incident depression in myocardial infarction patients. Biological Psychiatry 65, e7–e8.CrossRefGoogle ScholarPubMed
de Jonge, P, Ormel, J, van den Brink, RH, van Melle, JP, Spijkerman, TA, Kuijper, A, van Veldhuisen, DJ, van den Berg, MP, Honig, A, Crijns, HJ, Schene, AH (2006 a). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 163, 138–144.CrossRefGoogle ScholarPubMed
de Jonge, P, van den Brink, RH, Spijkerman, TA, Ormel, J (2006 b). Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. Journal of the American College of Cardiology 48, 2204–2208.CrossRefGoogle ScholarPubMed
Doyle, F, Conroy, R, McGee, H, Delaney, M (2010). Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis. Journal of Psychosomatic Research 68, 121–130.CrossRefGoogle ScholarPubMed
Elovainio, M, Keltikangas-Jarvinen, L, Kivimaki, M, Pulkki, L, Puttonen, S, Heponiemi, T, Juonala, M, Viikari, JS, Raitakari, OT (2005). Depressive symptoms and carotid artery intima-media thickness in young adults: the Cardiovascular Risk in Young Finns Study. Psychosomatic Medicine 67, 561–567.CrossRefGoogle ScholarPubMed
Glassman, AH, O'Connor, CM, Califf, RM, Swedberg, K, Schwartz, P, Bigger, Jr. JT, Krishnan, KR, van Zyl, LT, Swenson, JR, Finkel, MS, Landau, C, Shapiro, PA, Pepine, CJ, Mardekian, J, Harrison, WM, Barton, D, McIvor, M (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701–709.CrossRefGoogle ScholarPubMed
Holewijn, S, den Heijer, M, Swinkels, DW, Stalenhoef, AF, de Graaf, J (2009). Brachial artery diameter is related to cardiovascular risk factors and intima-media thickness. European Journal of Clinical Investigation 39, 554–560.CrossRefGoogle ScholarPubMed
Hoogendoorn, EH, Hermus, AR, de Vegt, F, Ross, HA, Verbeek, AL, Kiemeney, LA, Swinkels, DW, Sweep, FC, den Heijer, M (2006). Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex. Clinical Chemistry 52, 104–111.CrossRefGoogle Scholar
IDF (2009). The IDF consensus worldwide definition of the metabolic syndrome (www.idf.org/webdata/docs/IDF_Meta_def_final.pdf).Google Scholar
Jones, DJ, Bromberger, JT, Sutton-Tyrrell, K, Matthews, KA (2003). Lifetime history of depression and carotid atherosclerosis in middle-aged women. Archives of General Psychiatry 60, 153–160.CrossRefGoogle ScholarPubMed
Kendler, KS, Gardner, CO, Fiske, A, Gatz, M (2009). Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity. Archives of General Psychiatry 66, 857–863.CrossRefGoogle ScholarPubMed
Kriegsman, DM, Penninx, BW, van Eijk, JT, Boeke, AJ, Deeg, DJ (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. Journal of Clinical Epidemiology 49, 1407–1417.CrossRefGoogle Scholar
Krishnan, KR, Taylor, WD, McQuoid, DR, MacFall, JR, Payne, ME, Provenzale, JM, Steffens, DC (2004). Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biological Psychiatry 55, 390–397.CrossRefGoogle ScholarPubMed
Lesperance, F, Frasure-Smith, N, Koszycki, D, Laliberte, MA, van Zyl, LT, Baker, B, Swenson, JR, Ghatavi, K, Abramson, BL, Dorian, P, Guertin, MC (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297, 367–379.CrossRefGoogle ScholarPubMed
Lindgren, TG, Fukuoka, Y, Rankin, SH, Cooper, BA, Carroll, D, Munn, YL (2008). Cluster analysis of elderly cardiac patients' prehospital symptomatology. Nursing Research 57, 14–23.CrossRefGoogle ScholarPubMed
Linke, SE, Rutledge, T, Johnson, BD, Vaccarino, V, Bittner, V, Cornell, CE, Eteiba, W, Sheps, DS, Krantz, DS, Parashar, S, Bairey Merz, CN (2009). Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. Archives of General Psychiatry 66, 499–507.CrossRefGoogle ScholarPubMed
Martens, EJ, Hoen, PW, Mittelhaeuser, M, de Jonge, P, Denollet, J (2010). Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychological Medicine 40, 807–814.CrossRefGoogle ScholarPubMed
Naarding, P, Tiemeier, H, Breteler, MM, Schoevers, RA, Jonker, C, Koudstaal, PJ, Beekman, AT (2007). Clinically defined vascular depression in the general population. Psychological Medicine 37, 383–392.CrossRefGoogle ScholarPubMed
Nijm, J, Kristenson, M, Olsson, AG, Jonasson, L (2007). Impaired cortisol response to acute stressors in patients with coronary disease. Implications for inflammatory activity. Journal of Internal Medicine 262, 375–384.CrossRefGoogle ScholarPubMed
Pedersen, SS, Denollet, J, Daemen, J, van de Sande, M, de Jaegere, PT, Serruys, PW, Erdman, RA, van Domburg, RT (2007). Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents. Journal of Psychosomatic Research 62, 455–461.CrossRefGoogle ScholarPubMed
Pizzi, C, Manzoli, L, Mancini, S, Costa, GM (2008). Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. European Heart Journal 29, 1110–1117.CrossRefGoogle Scholar
Raison, CL, Capuron, L, Miller, AH (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in Immunology 27, 24–31.CrossRefGoogle ScholarPubMed
Scarisbrick, IA, Jones, EG, Isackson, PJ (1993). Coexpression of mRNAs for NGF, BDNF, and NT-3 in the cardiovascular system of the pre- and postnatal rat. Journal of Neuroscience 13, 875–893.CrossRefGoogle ScholarPubMed
Scherrer, JF, Xian, H, Bucholz, KK, Eisen, SA, Lyons, MJ, Goldberg, J, Tsuang, M, True, WR (2003). A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosomatic Medicine 65, 548–557.CrossRefGoogle ScholarPubMed
Schuett, H, Luchtefeld, M, Grothusen, C, Grote, K, Schieffer, B (2009). How much is too much? Interleukin-6 and its signalling in atherosclerosis. Thrombosis and Haemostasis 102, 215–222.CrossRefGoogle ScholarPubMed
Shrive, FM, Stuart, H, Quan, H, Ghali, WA (2006). Dealing with missing data in a multi-question depression scale: a comparison of imputation methods. BMC Medical Research Methodology 6, 57.CrossRefGoogle Scholar
Smith, PJ, Blumenthal, JA, Babyak, MA, Doraiswamy, PM, Hinderliter, A, Hoffman, BM, Waugh, R, Sherwood, A (2009). Intima-media thickness and age of first depressive episode. Biological Psychology 80, 361–364.CrossRefGoogle ScholarPubMed
Spitzer, C, Volzke, H, Barnow, S, Krohn, U, Wallaschofski, H, Ludemann, J, John, U, Freyberger, HJ, Kerner, W, Grabe, HJ (2008). Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes. Diabetic Medicine 25, 349–354.CrossRefGoogle ScholarPubMed
Stampfer, MJ, Hu, FB, Manson, JE, Rimm, EB, Willett, WC (2000). Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine 343, 16–22.CrossRefGoogle ScholarPubMed
Steffens, DC (2004). Establishing diagnostic criteria for vascular depression. Journal of Neurological Science 226, 59–62.CrossRefGoogle ScholarPubMed
ter Avest, E, Holewijn, S, Stalenhoef, AF, de Graaf, J (2005). Variation in non-invasive measurements of vascular function in healthy volunteers during daytime. Clinical Science (London) 108, 425–431.CrossRefGoogle ScholarPubMed
Tiemeier, H, Breteler, MM, van Popele, NM, Hofman, A, Witteman, JC (2003). Late-life depression is associated with arterial stiffness: a population-based study. Journal of the American Geriatric Society 51, 1105–1110.CrossRefGoogle ScholarPubMed
Tiemeier, H, van Dijck, W, Hofman, A, Witteman, JC, Stijnen, T, Breteler, MM (2004). Relationship between atherosclerosis and late-life depression: the Rotterdam Study. Archives of General Psychiatry 61, 369–376.CrossRefGoogle ScholarPubMed
Van der Kooy, K, van Hout, H, Marwijk, H, Marten, H, Stehouwer, C, Beekman, A (2007). Depression and the risk for cardiovascular diseases: systematic review and meta analysis. International Journal of Geriatric Psychiatry 22, 613–626.CrossRefGoogle ScholarPubMed
van Melle, JP, de Jonge, P, Honig, A, Schene, AH, Kuyper, AM, Crijns, HJ, Schins, A, Tulner, D, van den Berg, MP, Ormel, J (2007). Effects of antidepressant treatment following myocardial infarction. British Journal of Psychiatry 190, 460–466.CrossRefGoogle ScholarPubMed
Vreeburg, SA, Hoogendijk, WJ, van Pelt, J, Derijk, RH, Verhagen, JC, van Dyck, R, Smit, JH, Zitman, FG, Penninx, BW (2009). Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Archives of General Psychiatry 66, 617–626.CrossRefGoogle ScholarPubMed
Wouts, L, Oude Voshaar, RC, Bremmer, MA, Buitelaar, JK, Penninx, BW, Beekman, AT (2008). Cardiac disease, depressive symptoms, and incident stroke in an elderly population. Archives of General Psychiatry 65, 596–602.CrossRefGoogle Scholar