Relation of Inflammation to Depression and Incident Coronary Heart Disease (from the Canadian Nova Scotia Health Survey [NSHS95] Prospective Population Study)

Abstract

Numerous studies have found that depression is a strong independent risk factor for incident coronary heart disease (CHD), with increasing risk among those with higher levels of depressive symptoms. We examined the association between measures of inflammation (C-reactive protein, interleukin-6, soluble intracellular adhesion molecule-1), depressive symptoms, and CHD incidence among 1,794 participants of the population-based Canadian Nova Scotia Health Survey. There were 152 (8.5%) incident CHD events (141 nonfatal, 11 fatal) during the 15,514 person-years of observation (incidence rate=9.8 events/1000 person-years). Depression and inflammation were correlated at baseline and each significantly predicted CHD in separate models. When both risk factors were in the same model, each remained significant. The association between depressed group by the Center for Epidemiological Studies-Depression scale (score of 10+ vs. 0-9) and CHD incidence (HR=1.60, 95% CI = 1.12-2.27) was not reduced by the addition of inflammatory markers to the model (HR=1.59, 95% CI = 1.12-2.26). Findings were similar after adjustment for aspirin, lipid-lowering medication or anti-depressant use, and the association did not vary by sex, smoking status, age, obesity, cardiovascular medication use or antidepressant use. In conclusion, increased inflammation explains only a very small proportion of the association between depression and incident CHD.

When Blue-Collars Feel Blue

“…It might also be particularly helpful when searching for potential mediating factors that could ultimately be targeted in prevention strategies. 21,22 From a clinical perspective, the present results urge clinicians to consider depressive symptoms as a cardiovascular risk factor on their own when experienced by individuals of low occupational grade. Therefore, in addition to the management of more traditional risk factors, depressive symptoms could represent a specific target for cardiovascular preventive intervention among these individuals in a personalized medicine approach.…”

“…20 More direct, biological pathways, including imbalanced sympathetic-parasympathetic activity or chronic low-grade inflammation, are also hypothesized although evidence for their actual mediating role is weak. 21,22 Finally, subclinical vascular brain damages leading to poor emotion regulation might partially confound the association. 23 Likewise, several mechanisms may explain social inequalities in cardiovascular health.…”

Leukocyte-derived matrix metalloproteinase-9 in patients with coronary artery disease : Associations with psychological stress and glucocorticoid sensitivity

“…The theory of inflammation as a link between psychological stress and CAD has become a rather well-established fact over the years (177,178), even if this theory has been questioned lately. Some large prospective studies showing that psychological distress, such as depressivity and negative affect, predict risk of future CAD events, show that the risk remains after adjustment for the inflammatory markers CRP and IL-6 (98,179,180). Similarly, the inflammatory markers predict the incidence of CAD, but independently of the psychological factors.…”

Lifestyle Factors that can Induce an Independent and Persistent Low-Grade Systemic Inflammatory Response: A Wholistic Approach

“…Several other clinical trials [50,52,58,59,61] have inferred that there is a significant linkage between depression and inflammatory markers such as CRP, IL-6, and intercellular adhesion molecule-1 (ICAM-1). Nevertheless, the majority of them have concluded that inflammation accounts for only a small percentage of the cardiotoxic effect and the incidence of CHD of depression, indicating that multiple mechanisms are involved.…”