Abstract
Background and aimsMechanisms underlying the association between cardiovascular disease (CVD) and depression are unknown, and sex differences understudied. We investigated associations between a comprehensive set of measures of macro and microvascular disease and depressive symptoms in older men and women. MethodsWe performed cross-sectional analyses of the SABRE (Southall And Brent REvisited) population-based study. Participants (1396) attended clinic between 2008 and 2011 for assessment of subclinical macrovascular (carotid ultrasound, echocardiography, cerebral magnetic resonance imaging) and microvascular (retinopathy, nephropathy) disease, and depression. ResultsMean age of 1396 participants was 69.5 years, and 76.2% were male. The median (interquartile range) of depression score was 1 [0, 2] for men and 1 [0, 3] for women. All measures of subclinical macro and microvascular disease were adversely associated with depressive symptoms, even when known CVD was excluded. Physical activity partly explained some of these relationships. The association between left atrial dimension index (LADI), a measure of chronic elevated left ventricular filling pressure, and depressive symptoms was stronger in women (regression coefficient 0.23 [95% CI 0.11, 0.35]) than men (0.07 [-0.01, 0.15]), p for interaction 0.06, on multivariable adjustment. ConclusionsSubclinical macro and microvascular disease is associated with depressive symptoms, even in the absence of established CVD. These were in part accounted for by physical activity. We observed stronger association between LADI and depressive symptoms in women than in men. The beneficial role of physical activity in abrogating the association between subclinical CVD and depression warrants further investigation.
Highlights
There is an established and possibly bi-directional relationship be tween cardiovascular disease (CVD) and depression
Few studies have stratified their analyses by sex, and findings so far are inconsistent: higher subclinical atherosclerosis was associated with more severe depressive symptoms among men but not women in three studies [7,20,21] and in another study a negative association between CAC and depression was found in women and a U-shaped association in men [22]
When participants with GDS-10 ≥ 4 and/or use of antidepressant medications/hypnotics/ anxiolytics were considered as having depression, the prevalence of depression in women was higher than in men (19.9% vs 16.2%)
Summary
There is an established and possibly bi-directional relationship be tween cardiovascular disease (CVD) and depression. Data on relationships between other forms of microvascular disease and depression are scarce Most of these studies focused only on a single component of CVD, and, in older age, some did not exclude individuals with established CVD. Few studies have stratified their analyses by sex, and findings so far are inconsistent: higher subclinical atherosclerosis was associated with more severe depressive symptoms among men but not women in three studies [7,20,21] and in another study a negative association between CAC and depression was found in women and a U-shaped association in men [22] These studies only used a single measure of CVD and are unlikely to fully characterise sex differences in comorbid CVD and depression. We conducted a cross-sectional analysis to investigate the associa tion between a comprehensive set of measures of macro and microvas cular disease and depressive symptoms in a community-based population of older men and women with and without diagnosed car diovascular disease
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