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Associations Among Depression, Hemoglobin A1c Level, and Prognosis in Patients With Coronary Artery Disease: A
Weiya Li1, Han Yin1, Quanjun Liu2
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
High hemoglobin A1c (HbA1c) and depression worsen outcomes for coronary artery disease (CAD) patients, independent of diabetes. Managing both depression and HbA1c is crucial for better prognosis in CAD.
Area of Science:
- Cardiology
- Endocrinology
- Psychiatry
Background:
- Depression is common in coronary artery disease (CAD) patients.
- The link between depression and hemoglobin A1c (HbA1c) is debated.
- The combined impact of high HbA1c and depression on prognosis is unclear, particularly in non-diabetic CAD patients.
Purpose of the Study:
- To investigate the associations between depression, HbA1c levels, and prognosis in CAD patients.
- To explore these relationships in both diabetic and non-diabetic CAD populations.
- To determine if the combination of depression and high HbA1c poses a greater risk.
Main Methods:
- A prospective study included 558 CAD patients.
- Patients were categorized by HbA1c levels and clinical depression status.
- Cox proportional hazards models analyzed prognosis over a 2.2-year follow-up.
Main Results:
- High HbA1c, with or without depression, increased the risk of major adverse cardiovascular events (MACE) and composite events compared to low HbA1c without depression.
- Patients with both depression and high HbA1c showed the highest risk for MACE and composite events.
- In non-diabetic CAD patients, depression and high HbA1c significantly elevated risks for MACE, non-cardiac readmission, and composite events.
Conclusions:
- The coexistence of depression and high HbA1c significantly worsens prognosis in CAD patients, irrespective of diabetes status.
- For CAD patients experiencing depression, achieving lower HbA1c levels may be beneficial.
- This study highlights the importance of managing both glycemic control and mental health in CAD management.
Background:
Depression is ubiquitous in patients with coronary artery disease (CAD). The relationship between depression and hemoglobin A1c (HbA1c) is controversial. The combined effect of high HbA1c and depression on prognosis is unclear, especially in non-diabetic CAD patients. We sought to explore these associations.
Methods:
558 CAD patients were included in this prospective study. Patients were grouped by HbA1c levels and the status of clinical depression. The average follow-up period was about 2.2 years, and Cox proportional hazards models were used to compare the differences of prognosis in all the groups.
Results:
Clinical depression had no associations with HbA1c in all CAD patients (P for Pearson correlation = 0.74). In the all four groups, compared to group 1 (patients without clinical depression and low HbA1c), group 3 (without clinical depression and high HbA1c) had a higher risk of MACE (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.2-3.25) and composite events (aHR, 1.67; 95% CI, 1.09-2.053). Group 4 (patients with clinical depression and high HbA1c) had higher HRs for MACE (aHR, 2.9; 95%CI, 1.32-6.38) and composite events (aHR, 2.12; 95% CI, 1.06-4.25). In CAD patients without diabetes, patients with clinical depression and high HbA1c had a higher risk of MACE (HR, 2.71; 95% CI, 1.02-7.19), non-cardiac readmission (HR,3.48; 95% CI, 1.26-9.57) and composite events (HR,2.44; 95% CI, 1.08-5.53) than those with no clinical depression and low HbA1c. In patients with comorbidities of depression and diabetes, patients with depression and high HbA1c more likely to experienced non-cardiac readmissions (HR, 4.49; 95% CI, 1.31-15.38) than patients with no depression and low HbA1c only. In all the above analysis, p-values for interaction between clinical depression and HbA1c were not statistically significant.
Conclusions:
The presence of both depression and high HbA1c lead to a worse prognosis in CAD patients than one risk factor alone, no matter with or without the comorbidity of diabetes in these CAD patients. For patients with CAD and depression, lower HbA1c may be required.
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