Subclinical macro and microvascular disease is differently associated with depressive symptoms in men and women: Findings from the SABRE population-based study

Abstract

Background and aims Mechanisms 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. Methods We 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. Results Mean 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. Conclusions Subclinical 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.

Depression and Eye Disease—A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications

“…The vascular depression hypothesis, which posits that cerebrovascular disease and its contributing risk factors may contribute to late-life depression symptoms, also suggests that retinal microvascular changes may be a potentially helpful tool in predicting the risk of depression [ 120 ]. Depression has been associated with micro- and macrovascular disease, including total white matter hyperintensity volumes on magnetic resonance imaging (MRI) and retinopathy [ 121 ]. Chronic depression symptoms could lead to vascular dysfunction through nitric oxide regulation alterations [ 122 ].…”