Peripheral arterial disease and depressed mood in older men and women

Abstract

The objective of this study was to determine whether lower extremity peripheral arterial disease (PAD) is associated with depressive symptoms and whether PAD-related disability mediates the association between PAD and depressive symptoms. The study used a cross-sectional design set in an academic medical center. A cohort of men and women aged 55 years and older with (n = 93) or without (n = 74) PAD was recruited. PAD subjects were identified from a blood flow laboratory and a general medicine practice. Non-PAD subjects were identified from the same general medicine practice. PAD was diagnosed and quantified using the ankle-brachial index (ABI). Depressive symptoms were assessed by the 15-item short version of the Geriatric Depression Scale (GDS-S; score range 0-15, 0 = no depressive symptoms). The six-minute walk test and the Walking Impairment Questionnaire (WIQ) distance score (score range 0-100, 100 = better walking ability) were measures of walking impairment. PAD subjects had depressive mood (DM) (defined by GDS-S score >5) twice as often as controls (24% vs 12%, p = 0.06). After adjustment for age, education, and number of comorbidities, the prevalence of depressive mood among PAD subjects was increased, but this association was not significant (OR = 1.8, 95% CI 0.7-4.4). The WIQ distance score weakened the association between PAD and DM, and higher distance scores were associated with a lower likelihood of DM (OR = 0.98 per one unit of the WIQ, 95% CI 0.96-0.99). Among PAD subjects, severe PAD (ABI <0.5) was not significantly associated with DM (OR = 1.4, 95% CI 0.5-4.1), but a greater 6-min walk distance was associated with a lower likelihood of DM (OR = 0.8 per 100 feet, 95% CI 0.70-0.97). Substituting the WIQ scores for six-min walk distance in the model showed that higher WIQ scores were associated with lower likelihood of DM among PAD subjects (OR= 0.98 per one unit of the WIQ, 95% CI 0.95-1.0), though the association did not achieve statistical significance. In conclusion, these data suggest that PAD may be associated with an increased risk of DM and that this relationship may be related to PAD-associated disability. An evaluation for depression may be appropriate in men and women with PAD. Findings should be evaluated in a larger study cohort.

Vascular depression in older people with diabetes

“…Both PAD and stroke history were the strongest independent variables associated with depression and there were univariate associations with ischaemic infarcts in a subsample of patients with available neuroimaging. A link between PAD and depression in a cross-sectional clinicbased study was thought to be due to associated disability [45]. The Atherosclerosis Risk in Communities Study reported a modest association between baseline depressive symptoms and incident PAD [46].…”

Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization

“…[5][6][7] For patients with acute coronary syndromes, depression is a risk factor for recurrent cardiovascular events and mortality. [8][9][10] After coronary artery bypass surgery, it is associated with increased risk for recurrent cardiovascular events, 4,11 rehospitalization for cardiac events, 12 repeat coronary revascularization, 4 and death.…”

Clinically relevant depressive symptoms and peripheral arterial disease in elderly men and women. Results from a large cohort study in Southern China

“…Extra-coronary atherosclerosis (a combined measurement) was found to be associated with increased odds of having depressive disorders, although the relationship between ABI and depressive disorders alone was not significant. The lack of positive relationship in the study by Arseven et al [9] could be due to the small sample size. On the other hand, the lack of association between ABI and depressive disorders in the study by Tiemier et al [10] could be due to differences in the severity of peripheral atherosclerosis when compared to those in our study.…”

“…Previous studies on the association between peripheral arterial disease and depressive symptoms have yielded conflicting results. In a sample of 167 men and women clinic patients, using similar assessment instruments, Arseven et al [9] was unable to find an association between depressive symptoms and ABI. In another study consisting of a larger population with 4019 men and women aged 60 years or older, Tiemier et al [11] investigated the association between depression and atherosclerosis.…”

“…Although findings suggested that there was an increased risk of depressive symptoms in patients with known peripheral arterial diseases [9,10], few studies have explored this association in people with sub-clinical peripheral arterial disease. Although a recent large cross-sectional study [11] conducted in community dwelling Caucasian elderly has demonstrated a strong association between severe coronary and aortic calcifications and depression, no association between peripheral arterial diseases and depressive symptoms was found.…”