J Korean Med Sci.  2014 Nov;29(11):1507-1513. 10.3346/jkms.2014.29.11.1507.

Gender Differences in the Association between Depressive Symptoms and Carotid Atherosclerosis among Middle-Aged and Older Koreans: The Namwon Study

• Lee YH
• Shin MH
• Choi JS
• Nam HS
• Jeong SK
• Park KS
• Choi SW
• Kweon SS

• KMID: 2069932
• DOI: http://doi.org/10.3346/jkms.2014.29.11.1507

Abstract

We investigated the association of depressive symptoms with carotid intima-media thickness (IMT) and plaques in the general Korean population. A total of 7,554 Korean males and females aged 45-74 yr who were free from cardiovascular diseases were included in the analyses. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Subjects with a score of > or =16 were classified as having clinically significant depressive symptoms. Carotid ultrasonography was used to measure mean carotid IMT (C-IMT) and to determine the presence of plaques. A significant association between depressive symptoms and C-IMT was observed only in females. After adjustment for established cardiovascular risk factors, females with depressive symptoms had significantly greater C-IMT than females without depressive symptoms (mean difference 0.011+/-0.004 mm; 95% confidence interval, 0.003-0.019 mm). Compared with controls, the fully adjusted risk of females with depressive symptoms for abnormal C-IMT (> or =1.0 mm) was significant (odds ratio, 1.63; 95% confidence interval, 1.16-2.30). No significant association between depressive symptoms and carotid plaques was observed in either gender. This study shows a significant association between depressive symptoms and C-IMT in middle-aged and older females.

Keyword

Depression; Atherosclerosis; Carotid Intima-Media Thickness; Carotid Plaque Formation

MeSH Terms

Aged
Alcohol Drinking
Asian Continental Ancestry Group
Carotid Artery Diseases/complications/*diagnosis/ultrasonography
Carotid Intima-Media Thickness
Cross-Sectional Studies
Depression/*diagnosis/etiology/pathology
Female
Humans
Male
Middle Aged
Odds Ratio
Psychiatric Status Rating Scales
Questionnaires
Republic of Korea
Risk Factors
Sex Factors
Smoking

Reference

1. World Health Organization. The world health report 2002: reducing risks, promoting healthy life. Geneva: World Health Organization;2002.

2. Yamanaka G, Otsuka K, Hotta N, Murakami S, Kubo Y, Matsuoka O, Takasugi E, Yamanaka T, Shinagawa M, Nunoda S, et al. Depressive mood is independently related to stroke and cardiovascular events in a community. Biomed Pharmacother. 2005; 59:S31–S39.

3. Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004; 66:305–315.

4. Penninx BW, Beekman AT, Honig A, Deeg DJ, Schoevers RA, van Eijk JT, van Tilburg W. Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry. 2001; 58:221–227.

5. Schulz R, Beach SR, Ives DG, Martire LM, Ariyo AA, Kop WJ. Association between depression and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med. 2000; 160:1761–1768.

6. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997; 96:1432–1437.

7. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999; 340:14–22.

8. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007; 115:459–467.

9. Prati P, Tosetto A, Vanuzzo D, Bader G, Casaroli M, Canciani L, Castellani S, Touboul PJ. Carotid intima media thickness and plaques can predict the occurrence of ischemic cerebrovascular events. Stroke. 2008; 39:2470–2476.

10. Tiemeier H, van Dijck W, Hofman A, Witteman JC, Stijnen T, Breteler MM. Relationship between atherosclerosis and late-life depression: the Rotterdam Study. Arch Gen Psychiatry. 2004; 61:369–376.

11. Hamer M, Malan NT, Harvey BH, Malan L. Depressive symptoms and sub-clinical atherosclerosis in Africans: role of metabolic syndrome, inflammation and sympathoadrenal function. Physiol Behav. 2011; 104:744–748.

12. Elovainio M, Keltikangas-Järvinen L, Kivimäki M, Pulkki L, Puttonen S, Heponiemi T, Juonala M, Viikari JS, Raitakari OT. Depressive symptoms and carotid artery intima-media thickness in young adults: the Cardiovascular Risk in Young Finns Study. Psychosom Med. 2005; 67:561–567.

13. Haas DC, Davidson KW, Schwartz DJ, Rieckmann N, Roman MJ, Pickering TG, Gerin W, Schwartz JE. Depressive symptoms are independently predictive of carotid atherosclerosis. Am J Cardiol. 2005; 95:547–550.

14. Faramawi MF, Gustat J, Wildman RP, Rice J, Johnson E, Sherwin R. Relation between depressive symptoms and common carotid artery atherosclerosis in American persons > or =65 years of age. Am J Cardiol. 2007; 99:1610–1613.

15. Rice SC, Zonderman AB, Metter EJ, Najjar SS, Waldstein SR. Absence of relation between depressive symptoms and carotid intimal medial thickness in the Baltimore Longitudinal Study of Aging. Psychosom Med. 2009; 71:70–76.

16. Whipple MO, Lewis TT, Sutton-Tyrrell K, Matthews KA, Barinas-Mitchell E, Powell LH, Everson-Rose SA. Hopelessness, depressive symptoms, and carotid atherosclerosis in women: the Study of Women's Health Across the Nation (SWAN) heart study. Stroke. 2009; 40:3166–3172.

17. Kweon SS, Shin MH, Jeong SK, Nam HS, Lee YH, Park KS, Ryu SY, Choi SW, Kim BH, Rhee JA, et al. Cohort profile: the Namwon study and the Dong-gu study. Int J Epidemiol. 2014; 43:558–567.

18. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1:385–401.

19. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol. 1997; 146:483–494.

20. Casella IB, Presti C, Porta RM, Sabbag CR, Bosch MA, Yamazaki Y. A practical protocol to measure common carotid artery intima-media thickness. Clinics (Sao Paulo). 2008; 63:515–520.

21. Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002; 53:897–902.

22. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry. 1998; 55:580–592.

23. Jones DJ, Bromberger JT, Sutton-Tyrrell K, Matthews KA. Lifetime history of depression and carotid atherosclerosis in middle-aged women. Arch Gen Psychiatry. 2003; 60:153–160.

24. Kilbourne AM, Reynolds CF 3rd, Good CB, Sereika SM, Justice AC, Fine MJ. How does depression influence diabetes medication adherence in older patients? Am J Geriatr Psychiatry. 2005; 13:202–210.

25. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, Järvisalo MJ, Uhari M, Jokinen E, Ronnemaa T, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003; 290:2277–2283.