Relation of Persistent Depressive Symptoms to Coronary Artery Calcification in Women Aged 46 to 59 Years

Abstract

Depressive disorders have been associated with cardiovascular disease (CVD), but the impact of depression on early atherogenesis has not been well described, particularly in women and minorities. The relationship between repeated episodes of high depressive symptoms and coronary calcium (CAC) is unknown in women at midlife when depression is common. Participants in the Study of Women’s Health Across the Nation Heart study were assessed annualy for depressive symptoms (CES-D scale) over 5 years prior to CAC assessment and classified as high (CES-D≥16) or not. CAC, measured by computed tomography, was analyzed as a categorical variable using cumulative logit partial proportional odds models. In these middle-aged women free of CVD and diabetes (194 black, 334 white), high depressive symptoms over five years were common; 19% had 1, 9% had 2, and 11% experienced ≥3 episodes. Coronary calcium was low; 54% had no CAC, 25% had scores between 0 and 10, and 21% had CAC≥10 Agatston score. After adjusting for CVD risk factors, women with ≥3 episodes were twice as likely to have significant CAC (≥10 Agatston units) than women with no depressive episodes [OR (95% CI)=2.20 (1.13–4.28), p=0.020] with no difference by race. Women with 1 or 2 episodes did not differ from women with no episodes. In conclusion, in healthy women aged 46 to 59 years without clinical CVD or diabetes, persistent depressive symptoms were significantly associated with elevated CAC scores, suggesting that they are more likely to have pathophysiological and behavioral effects on the development of subclinical CVD than does a single episode of elevated depressive symptoms.

Interaction between smoking and depressive symptoms with subclinical heart disease in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

“…By measuring cumulative smoking and repeatedly evaluating current depressive symptoms, we were able to model the chronicity of smoking and depressive symptoms over time. With regard to depressive symptoms, our results are similar to those reported by Hamer et al (2010) and I. Janssen et al (2016) in that the authors observed that persistent episodes, but not one episode of elevated depressive symptoms, predicted CAC.…”

“…Persistent depression is associated with subclinical heart disease, even after adjusting for smoking status (Agatisa et al, 2005; Hamer, Kivimaki, Lahiri, Marmot, & Steptoe, 2010; I. Janssen et al, 2016; Matthews, Chang, Sutton-Tyrrell, Edmundowicz, & Bromberger, 2010), and relative risk of CAC progression increases for each incremental increase in depressive symptoms (Imke Janssen et al, 2011), though the latter study did not adjust for smoking status.…”

Coronary calcinosis and psychological distress association, by the data from ESSE-RF study in Kemerovskaya Region

“…Поскольку на КИ могут влиять различные факторы, в т. ч. психосоциальные, то ассоциация последних с кальцификацией коронарных артерий и ее прогрессированием также становится предметом исследований. В настоящее время такую ассоциацию удалось показать для таких факторов как депрессия и хронический стресс [4]. Среди здоровых женщин в возрасте 46-59 лет наличие ≥3 эпизодов депрессии частота выявления значительного кальциноза коронарных артерий (индекс Агатстона ≥10) была в 2 раза выше, чем у женщин без таких эпизодов -ОР 2,20; 95% ДИ 1,13-4,28 (p=0,020) [4].…”

“…В эпидемиологических исследованиях было показано, что уровень гормонов стресса (в частности, кортизола) был ассоциирован с более высокими значениями кальциевого индекса (КИ) коронарных артерий [3]. Наличие симптомов депрессии также было ассоциировано с наличием субклинического поражения коронарных артерий [4] и прогрессированием атеросклеротического процесса [5]. Исходя из этого, логичны, с одной стороны, выявление депрессии и коррекция ее проявлений [1], а с другой стороныпопытки предотвратить развитие депрессивных симптомов.…”

“…Стандартный протокол исследования ЭССЕ-РФ расширен определением типа личности, которое проводилось с использованием опросника DS-14 (Type D Scale) [3] из русскоязычного варианта руководства Европейского общества кардиологов [4]. Пациентам предлагали 14 вопросов и 5 вариантов ответов на них: неверно, скорее неверно, трудно сказать, пожалуй, верно, совершенно верно.…”