Depression, the metabolic syndrome and cardiovascular risk
Viola Vaccarino1, Candace McClure, B Delia Johnson
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1256 Briarcliff Road NE, Suite-1 North, Atlanta, GA 30306, USA. viola.vaccarino@emory.edu
Insights
Depression is linked to metabolic syndrome and cardiovascular disease (CVD) risk in women. Metabolic syndrome is independently associated with depression but does not fully explain the increased CVD risk in depressed individuals.
Area of Science:
- Cardiology
- Psychiatry
- Metabolic Health
Background:
- The interplay between depression, metabolic syndrome, and cardiovascular disease (CVD) risk remains incompletely understood.
- It is unknown if metabolic syndrome mediates the association between depression and CVD risk.
Purpose of the Study:
- To investigate the relationship between depression and metabolic syndrome.
- To determine if metabolic syndrome explains the association between depression and incident cardiovascular disease (CVD) events in women.
Main Methods:
- The study included 652 women undergoing coronary angiography from the Women's Ischemia Syndrome Evaluation (WISE) study.
- Depression was assessed using the Beck Depression Inventory (BDI), categorizing women into high-risk (elevated symptoms and prior diagnosis), intermediate, and low-risk groups.
- Metabolic syndrome was defined by ATP-III criteria, and adverse CVD events (myocardial infarction, stroke, heart failure, CVD mortality) were tracked over a median of 5.9 years.
Main Results:
- Both depression categories showed approximately 60% increased odds of metabolic syndrome (p = .03), with more risk factors in higher depression groups (p = .003).
- Women with high-risk depression had 2.6 times higher CVD risk. Adding metabolic syndrome to the model only reduced depression's CVD risk association by 7%.
- Both depression and metabolic syndrome independently predicted CVD events.
Conclusions:
- Metabolic syndrome is independently associated with depression in women with suspected coronary artery disease.
- Metabolic syndrome explains only a minor part of the link between depression and the occurrence of CVD events.
Background:
The relationship between depression and the metabolic syndrome is unclear, and whether metabolic syndrome explains the association between depression and cardiovascular disease (CVD) risk is unknown.
Methods:
We studied 652 women who received coronary angiography as part of the Women's Ischemia Syndrome Evaluation (WISE) study and completed the Beck Depression Inventory (BDI). Women who had both elevated depressive symptoms (BDI > or =10) and a previous diagnosis of depression were considered at highest risk, whereas those with one of the two conditions represented an intermediate group. The metabolic syndrome was defined according to the ATP-III criteria. The main outcome was incidence of adverse CVD events (hospitalizations for myocardial infarction, stroke, congestive heart failure, and CVD-related mortality) over a median follow-up of 5.9 years.
Results:
After adjusting for demographic factors, lifestyle and functional status, both depression categories were associated with about 60% increased odds for metabolic syndrome compared with no depression (p = .03). The number of metabolic syndrome risk factors increased gradually across the three depression categories (p = .003). During follow-up, 104 women (15.9%) experienced CVD events. In multivariable analysis, women with both elevated symptoms and a previous diagnosis of depression had 2.6 times higher risk of CVD. When metabolic syndrome was added to the model, the risk associated with depression only decreased by 7%, and both depression and metabolic syndrome remained significant predictors of CVD.
Conclusions:
In women with suspected coronary artery disease, the metabolic syndrome is independently associated with depression but explains only a small portion of the association between depression and incident CVD.
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