Cardiovascular risk indicators among depressed persons: A special case?
Elisabeth M van Zutphen1, Almar A L Kok2, Majon Muller3
1Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands.
Insights
Depression symptom severity and anxiety indicate higher cardiovascular risk in depressed individuals. However, these factors offer minimal improvement to existing cardiovascular risk prediction models for this population.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Traditional cardiovascular risk factors incompletely explain cardiovascular disease (CVD) risk in depressed individuals.
- Depression may involve unique risk indicators like symptom severity, insomnia, loneliness, and neuroticism.
- Limited research exists on the added predictive value of depression-related characteristics for CVD risk.
Purpose of the Study:
- To investigate whether depression-related characteristics improve cardiovascular risk prediction in depressed adults beyond traditional indicators.
- To assess the incremental value of specific depression-related factors in predicting incident CVD.
Main Methods:
- Utilized data from 1028 depressed Dutch adults without prevalent CVD from two longitudinal cohort studies.
- Assessed medication-confirmed self-reported CVD as the outcome.
- Included fifteen depression-related characteristics and traditional cardiovascular risk indicators, analyzed using Cox regression and c-statistics for incremental value.
Main Results:
- During a median 65.3-month follow-up, 12.7% developed CVD.
- Only anxiety and depressive symptom severity were associated with incident CVD beyond traditional risk factors.
- Including anxiety or depression severity marginally increased model predictive ability (0.56 or 0.33 percentage points, respectively) from a baseline c-statistic of 85.47%.
Conclusions:
- Anxiety and depressive symptom severity are associated with increased cardiovascular risk in depressed persons.
- These factors provide limited incremental value for cardiovascular risk assessment in this population.
- Existing cardiovascular risk prediction models require validation specifically in depressed individuals.
Background:
Traditional cardiovascular risk indicators only partially explain cardiovascular risks in depressed persons. Depressed persons may exhibit a profile of cardiovascular risk indicators that goes beyond traditional cardiovascular risk indicators, such as symptom severity, insomnia, loneliness and neuroticism, yet research on the added value of these depression-related characteristics in predicting cardiovascular risks of depressed persons is scarce.
Methods:
Data from N = 1028 depressed Dutch adults without prevalent CVD were derived from two longitudinal depression cohort studies. The outcome was medication-confirmed self-reported CVD. Fifteen depression-related clinical and psychological characteristics were included and tested against traditional cardiovascular risk indicators. Data were analysed using Cox regression models. Incremental values of these characteristics were calculated using c-statistics.
Results:
After a median follow-up of 65.3 months, 12.7% of the participants developed CVD. Only anxiety and depressive symptom severity were associated with incident CVD beyond traditional cardiovascular risk indicators. The c-statistic of the model with traditional cardiovascular risk indicators was 85.47%. This increased with 0.56 or 0.33 percentage points after inclusion of anxiety or depression severity, respectively.
Limitations:
Other relevant depression-related characteristics were not available in the datasets used.
Conclusion:
Anxiety and depressive symptom severity were indicative of an increased cardiovascular risk. Including these as additional risk indicators barely improved the ability to assess cardiovascular risks in depressed persons. Although traditional cardiovascular risk indicators performed well in depressed persons, existing risk prediction algorithms need to be validated in depressed persons.
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