Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Bhautesh Dinesh Jani, Jonathan Cavanagh, Sarah JE Barry, Geoff Der, Naveed Sattar, Frances S Mair

Published in: BMC Cardiovascular Disorders | Issue 1/2014

Login to get access

Abstract

Background

Depression 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.

Methods

We 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.

Results

SBP 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.

Conclusion

In 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.
Appendix
Available only for authorised users
Literature
1.
Egede LE: Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007, 29: 409-416. 10.1016/j.genhosppsych.2007.06.002.CrossRefPubMed
2.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370: 851-858. 10.1016/S0140-6736(07)61415-9.CrossRefPubMed
3.
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K: The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006, 23: 1165-1173. 10.1111/j.1464-5491.2006.01943.x.CrossRefPubMed
4.
Hadidi N, Treat-Jacobson DJ, Lindquist R: Poststroke depression and functional outcome: a critical review of literature. Hear Lung. 2009, 38: 151-162. 10.1016/j.hrtlng.2008.05.002.CrossRef
5.
Whooley MA, De JP, Vittinghoff E, Otte C, Moos R, Carney RM, Ali S, Dowray S, Na B, Feldman MD, Schiller NB, Browner WS: Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA. 2008, 300: 2379-2388. 10.1001/jama.2008.711.CrossRefPubMedPubMedCentral
6.
Larsen KK, Christensen B, Sondergaard J, Vestergaard M: Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction: A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions. PLoS One. 2013, 8: e74393-10.1371/journal.pone.0074393.CrossRefPubMedPubMedCentral
7.
Katon WJ, Rutter C, Simon G, Lin EH, Ludman E, Ciechanowski P, Kinder L, Young B, Von KM: The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005, 28: 2668-2672. 10.2337/diacare.28.11.2668.CrossRefPubMed
8.
Pozuelo L, Tesar G, Zhang J, Penn M, Franco K, Jiang W: Depression and heart disease: what do we know, and where are we headed?. Cleve Clin J Med. 2009, 76: 59-70. 10.3949/ccjm.75a.08011.CrossRefPubMed
9.
Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES: Depression and coronary heart disease: recommendations for screening, referral, and treatment. Circulation. 2008, 118: 1768-1775. 10.1161/CIRCULATIONAHA.108.190769.CrossRefPubMed
10.
Ontario HQ: Screening and management of depression for adults with chronic diseases: an evidence-based analysis. Ont Health Technol Assess Ser. 2013, 13: 1-45.
11.
Thombs BD, Roseman M, Coyne JC, de Jonge P, Delisle VC, Arthurs E, Levis B, Ziegelstein RC: Does Evidence Support the American Heart Association’s Recommendation to Screen Patients for Depression in Cardiovascular Care? An Updated Systematic Review. PLoS One. 2013, 8: e52654-10.1371/journal.pone.0052654.CrossRefPubMedPubMedCentral
12.
Smolderen KG, Buchanan DM, Amin AA, Gosch K, Nugent K, Riggs L, Seavey G, Spertus JA: Real-world lessons from the implementation of a depression screening protocol in acute myocardial infarction patients: implications for the American Heart Association depression screening advisory. Circ Qual Outcomes. 2011, 4: 283-292. 10.1161/CIRCOUTCOMES.110.960013.CrossRef
13.
Burton C, Simpson C, Anderson N: Diagnosis and treatment of depression following routine screening in patients with coronary heart disease or diabetes: a database cohort study. Psychol Med. 2013, 43: 529-537. 10.1017/S0033291712001481.CrossRefPubMed
14.
Jani BD, Purves D, Barry S, Cavanagh J, McLean G, Mair FS: Challenges and Implications of Routine Depression Screening for Depression in Chronic Disease and Multimorbidity: A Cross Sectional Study. PLoS One. 2013, 8: e74610-10.1371/journal.pone.0074610.CrossRefPubMedPubMedCentral
15.
NICE: Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. 2009
16.
Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, Demyttenaere K, Gasquet I, Haro JM, Karam E, Kessler RC, Levinson D, Medina Mora ME, Oakley Browne MA, Ormel J, Villa JP, Uda H, Von Korff M: Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes (Lond). 2008, 32: 192-200. 10.1038/sj.ijo.0803701.CrossRef
17.
De Wit L, Luppino F, van Straten A, Penninx B, Zitman F, Cuijpers P: Depression and obesity: A meta-analysis of community-based studies. Psychiatry Res. 2010, 178: 230-235. 10.1016/j.psychres.2009.04.015.CrossRefPubMed
18.
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG: Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010, 67: 220-229. 10.1001/archgenpsychiatry.2010.2.CrossRefPubMed
19.
Meng L, Chen D, Yang Y, Zheng Y, Hui R: Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens. 2012, 30: 842-851. 10.1097/HJH.0b013e32835080b7.CrossRefPubMed
20.
Ancelin ML, Carrire I, Boulenger JP, Malafosse A, Stewart R, Cristol JP, Ritchie K, Chaudieu I, Dupuy AM: Gender and genotype modulation of the association between lipid levels and depressive symptomatology in community-dwelling elderly (The ESPRIT Study). Biol Psychiatry. 2010, 68: 125-132. 10.1016/j.biopsych.2010.04.011.CrossRefPubMed
21.
Hamer M, Batty GD, Kivimaki M: Haemoglobin A1c, fasting glucose and future risk of elevated depressive symptoms over 2 years of follow-up in the English Longitudinal Study of Ageing. Psychol Med. 2011, 41: 1889-1896. 10.1017/S0033291711000079.CrossRefPubMedPubMedCentral
22.
Pater C: The Blood Pressure “Uncertainty Range” - a pragmatic approach to overcome current diagnostic uncertainties (II). Curr Control Trials Cardiovasc Med. 2005, 6: 5-10.1186/1468-6708-6-5.CrossRefPubMedPubMedCentral
23.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense H-W, Joffres M, Kastarinen M, Poulter N, Primatesta P, Rodríguez-Artalejo F, Stegmayr B, Thamm M, Tuomilehto J, Vanuzzo D, Vescio F: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003, 289: 2363-2369. 10.1001/jama.289.18.2363.CrossRefPubMed
24.
Penman AD, Johnson WD: The changing shape of the body mass index distribution curve in the population: implications for public health policy to reduce the prevalence of adult obesity. Prev Chronic Dis. 2006, 3: A74-PubMedPubMedCentral
25.
Thompson R, O’Regan C, Morant S, Phillips B, Ong S: Measurement of baseline total cholesterol: new data from The Health Improvement Network (THIN) database. Prim Care Cardiovasc J. 2008, 1: 107-10.3132/pccj.2008.028.CrossRef
26.
Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD: Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010, 375: 481-489. 10.1016/S0140-6736(09)61969-3.CrossRefPubMed
27.
28.
29.
Team RC: R Core Team (2012). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2012, ISBN 3-900051-07-0. http://​www.​R-project.​org/​
30.
Barrett-Connor E, Palinkas LA: Low blood pressure and depression in older men: a population based study. BMJ. 1994, 308: 446-449. 10.1136/bmj.308.6926.446.CrossRefPubMedPubMedCentral
31.
Stroup-Benham CA, Markides KS, Black SA, Goodwin JS: Relationship between low blood pressure and depressive symptomatology in older people. J Am Geriatr Soc. 2000, 48: 250-255.CrossRefPubMed
32.
33.
Niu K, Hozawa A, Awata S, Guo H, Kuriyama S, Seki T, Ohmori-Matsuda K, Nakaya N, Ebihara S, Wang Y, Tsuji I, Nagatomi R: Home blood pressure is associated with depressive symptoms in an elderly population aged 70 years and over: a population-based, cross-sectional analysis. Hypertens Res. 2008, 31: 409-416. 10.1291/hypres.31.409.CrossRefPubMed
34.
Kim B-S, Bae JN, Cho MJ: Depressive symptoms in elderly adults with hypotension: different associations with positive and negative affect. J Affect Disord. 2010, 127: 359-364. 10.1016/j.jad.2010.06.024.CrossRefPubMed
35.
Jorm AF: Association of hypotension with positive and negative affect and depressive symptoms in the elderly. Br J Psychiatry. 2001, 178: 553-555. 10.1192/bjp.178.6.553.CrossRefPubMed
36.
Morgan RE, Palinkas LA, Barrett-Connor EL, Wingard DL: Plasma cholesterol and depressive symptoms in older men. Lancet. 1993, 341: 75-79. 10.1016/0140-6736(93)92556-9.CrossRefPubMed
37.
Steegmans PH, Hoes AW, Bak AA, van der Does E, Grobbee DE: Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels. Psychosom Med. 2000, 62: 205-211. 10.1097/00006842-200003000-00009.CrossRefPubMed
38.
Kivimaki M, Tabak AG, Batty GD, Singh-Manoux A, Jokela M, Akbaraly TN, Witte DR, Brunner EJ, Marmot MG, Lawlor DA: Hyperglycemia, Type 2 Diabetes, and Depressive Symptoms: The British Whitehall II study. Diabetes Care. 2009, 32: 1867-1869. 10.2337/dc09-0716.CrossRefPubMedPubMedCentral
39.
Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP: What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TI. Circulation. 2010, 122: 2142-2151. 10.1161/CIRCULATIONAHA.109.905687.CrossRefPubMed
40.
Cushman WC, Evans GW, Byington RP, Goff DC, Grimm RH, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F: Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010, 362: 1575-1585.CrossRefPubMed
41.
Messerli FH, Panjrath GS: The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential?. J Am Coll Cardiol. 2009, 54: 1827-1834. 10.1016/j.jacc.2009.05.073.CrossRefPubMed
42.
Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F: Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006, 368: 666-678. 10.1016/S0140-6736(06)69251-9.CrossRefPubMed
43.
Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH, Probstfield JL, Simons-Morton DG, Friedewald WT: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008, 358: 2545-2559.CrossRefPubMed
44.
Ghadir MR, Riahin AA, Havaspour A, Nooranipour M, Habibinejad AA: The relationship between lipid profile and severity of liver damage in cirrhotic patients. Hepat Mon. 2010, 10: 285-288.PubMedPubMedCentral
45.
Marini A, Carulli G, Azzarà A, Grassi B, Ambrogi F: Serum cholesterol and triglycerides in hematological malignancies. Acta Haematol. 1989, 81: 75-79. 10.1159/000205530.CrossRefPubMed
46.
Kovesdy CP, Anderson JE, Kalantar-Zadeh K: Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: effects of case mix and the malnutrition-inflammation-cachexia syndrome. J Am Soc Nephrol. 2007, 18: 304-311. 10.1681/ASN.2006060674.CrossRefPubMed
47.
O’Neil A, Sanna L, Redlich C, Sanderson K, Jacka F, Williams LJ, Pasco JA, Berk M: The impact of statins on psychological wellbeing: a systematic review and meta-analysis. BMC Med. 2012, 10: 154-10.1186/1741-7015-10-154.CrossRefPubMedPubMedCentral
48.
Macedo AF, Taylor FC, Casas JP, Adler A, Prieto-Merino D, Ebrahim S: Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. BMC Med. 2014, 12: 51-10.1186/1741-7015-12-51.CrossRefPubMedPubMedCentral
49.
Zureik M, Courbon D, Ducimetière P: Serum cholesterol concentration and death from suicide in men: Paris prospective study I. BMJ. 1996, 313: 649-651. 10.1136/bmj.313.7058.649.CrossRefPubMedPubMedCentral
50.
Olson MB, Kelsey SF, Matthews KA, Bairey Merz CN, Eteiba W, McGorray SP, Cornell CE, Vido DA, Muldoon MF: Lipid-lowering medication use and aggression scores in women: a report from the NHLBI-sponsored WISE study. J Womens Health (Larchmt). 2008, 17: 187-194. 10.1089/jwh.2007.0379.CrossRef
51.
Sullivan LE, Fiellin DA, O’Connor PG: The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med. 2005, 118: 330-341. 10.1016/j.amjmed.2005.01.007.CrossRefPubMed
52.
Van der Meer RM, Willemsen MC, Smit F, Cuijpers P: Smoking cessation interventions for smokers with current or past depression. Cochrane Database Syst Rev. 2013, 8: CD006102-PubMed
53.
Chaiton MO, Cohen JE, O’Loughlin J, Rehm J: A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health. 2009, 9: 356-10.1186/1471-2458-9-356.CrossRefPubMedPubMedCentral
54.
Blumenthal JA, Babyak MA, Carney RM, Huber M, Saab PG, Burg MM, Sheps D, Powell L, Taylor CB, Kaufmann PG: Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial. Med Sci Sports Exerc. 2004, 36: 746-755.CrossRefPubMed
55.
Karasz A, Dowrick C, Byng R, Buszewicz M, Ferri L, Olde Hartman TC, Van DS, van Weel-Baumgarten E, Reeve J: What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes. Br J Gen Pract. 2012, 62: e55-e63. 10.3399/bjgp12X616373.CrossRefPubMed
56.
Coventry PA, Hays R, Dickens C, Bundy C, Garrett C, Cherrington A, Chew-Graham C: Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Fam Pract. 2011, 12: 10-10.1186/1471-2296-12-10.CrossRefPubMedPubMedCentral
57.
Haddad M, Walters P, Phillips R, Tsakok J, Williams P, Mann A, Tylee A: Detecting Depression in Patients with Coronary Heart Disease: A Diagnostic Evaluation of the PHQ-9 and HADS-D in Primary Care, Findings From the UPBEAT-UK Study. PLoS One. 2013, 8: e78493-10.1371/journal.pone.0078493.CrossRefPubMedPubMedCentral
58.
Meader N, Mitchell AJ, Chew-Graham C, Goldberg D, Rizzo M, Bird V, Kessler D, Packham J, Haddad M, Pilling S: Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies. Br J Gen Pract. 2011, 61: e808-e820. 10.3399/bjgp11X613151.CrossRefPubMedPubMedCentral
Metadata
Title
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
Authors
Bhautesh Dinesh Jani
Jonathan Cavanagh
Sarah JE Barry
Geoff Der
Naveed Sattar
Frances S Mair
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-14-139

Other articles of this Issue 1/2014

BMC Cardiovascular Disorders 1/2014 Go to the issue

Research article

Gender-dependent associations between socioeconomic status and metabolic syndrome: a cross-sectional study in the adult Saudi population

Research article

Phenotype, origin and estimated prevalence of a common long QT syndrome mutation: a clinical, genealogical and molecular genetics study including Swedish R518X/KCNQ1families

Research article

Visit-to-visit blood pressure variability is a marker of cardiac diastolic function and carotid atherosclerosis

Study protocol

Balloon expandable transcatheter aortic valve implantation with or without pre-dilation of the aortic valve – rationale and design of a multicenter registry (EASE-IT)

Research article

Aspirin use and knowledge in the community: a population- and health facility based survey for measuring local health system performance

Research article

Statins and the risk of type 2 diabetes mellitus: cohort study using the UK clinical practice pesearch datalink

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits