Abstract 418: Is Depression a Risk Factor for Peripheral Arterial Disease? Insights from the Heart and Soul Study

Abstract

Objectives: Risk factors for peripheral artery disease (PAD) are tightly linked to those for coronary artery disease (CAD). Although depression is known to increase risk of CAD, fewer studies have evaluated depression and PAD, and the mechanisms linking depression and PAD remain unknown. We examined the association of depression with prevalent PAD and with prospective PAD events and evaluated potential mediators of these associations. Methods: We used data from the Heart and Soul Study, a prospective cohort of 1,024 men and women with CAD recruited in 2000-2002 and followed for a mean of 7.2 years with <5% loss to follow-up. Depression was assessed with the validated nine-item Patient Health Questionnaire. Prevalent PAD at baseline was determined by self-report. Prospective PAD events were adjudicated based on physician diagnosis, radiological imaging and/or need for PAD surgery. We used logistic and Cox models to estimate the independent associations of depression with prevalent PAD at baseline and subsequent PAD events, adjusting for potential mediators of these associations. Results: At baseline, depression affected 19% of patients. Prevalent PAD was reported by 12.1% of patients with depression and 7.3% of those without (age-adjusted OR 1.79, 95% CI 1.06-3.03, p=0.03). In age-adjusted models, physical inactivity, diabetes, and CRP level each explained more than 5% of the association between depression and prevalent PAD. During follow-up, PAD events occurred in 9% of patients with depression and 6% of those without (age-adjusted HR 1.77, 95% CI 1.02-3.07, p=0.04). Factors explaining more than 5% of the association between depression and incident PAD events included inactivity, diabetes, prevalent PAD, race/ethnicity, smoking, HDL, and triglyceride levels. Conclusions: Depression was associated with a greater risk of PAD at baseline and with prospective PAD events, providing evidence that depression is an important risk factor for the development of PAD. Since elevations in traditional, modifiable cardiovascular risk factors partially explain these associations, such risk factors should be assessed and aggressively treated. Furthermore, this study emphasizes the importance of depression screening and treatment in patients with PAD.