Revisiting the J shaped curve, exploring the association between cardiovascular risk factors and concurrent depressive symptoms in patients with cardiometabolic disease: findings from a large cross-sectional study

Jani, B. , Cavanagh, J., Barry, S. J.E. , Der, G. , Sattar, N. and Mair, F. S. (2014) Revisiting the J shaped curve, exploring the association between cardiovascular risk factors and concurrent depressive symptoms in patients with cardiometabolic disease: findings from a large cross-sectional study. BMC Cardiovascular Disorders, 14, p. 139. (doi:10.1186/1471-2261-14-139)

[img]
Preview
Text
99068.pdf - Published Version
Available under License Creative Commons Attribution.

682kB

Publisher's URL: http://dx.doi.org/10.1186/1471-2261-14-139

Abstract

<b>Background</b> Depression is common in patients with cardiometabolic diseases but little is known about the relationship, if any, between cardiovascular risk factor values and depressive symptoms in patients with these conditions. The objective of this paper is to study the association between cardiovascular risk factors and concurrent depressive symptoms in patients with three common cardiometabolic conditions: coronary heart disease (CHD), stroke and diabetes.<p></p> <b>Methods</b> We retrospectively reviewed primary care data for N = 35537 with 1 of the above 3 conditions who underwent depression screening using the depressive subscale of hospital anxiety and depression score (HADS-D). We reviewed 4 cardiometabolic risk factors (Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], BMI and total cholesterol) recorded concurrently in all patients and HbA1c in patients with diabetes (n = 18453). We analysed the association between individual risk factor value and a positive HADS-D screening result (>7) using logistic regression.<p></p> <b>Results</b> SBP and BMI were noted to have a non-linear "J-shaped" relationship with the probability of having a positive HADS-D and observed nadirs (levels with the lowest probability) of 148 mm Hg and 30.70 kg/m2, respectively. Total cholesterol and DBP found to have a weaker curvilinear association with concurrent depression symptoms and nadirs of 3.60 mmol/l and 74 mmHg. Among patients with Diabetes, HbA1c was also found to have a "J-shaped" relationship with probability of having a positive HADS-D with an observed nadir of 7.06% DCCT. The above relationships remain significant after adjusting for age, sex, socio-economic status and number of co-morbid conditions.<p></p> <b>Conclusion</b> In patients with cardiometabolic disease, cardiovascular risk factor values at both extremes were associated with higher positive depression screening after adjusting for confounders. These findings have potentially important implications for clinical practice in relation to both risk stratification for depression and approaches to secondary prevention in individuals with cardiometabolic disease and merit further investigation to determine the nature and direction of the observed association.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Der, Mr Geoffrey and Cavanagh, Professor Jonathan and Jani, Dr Bhautesh and Barry, Dr Sarah and Sattar, Professor Naveed
Authors: Jani, B., Cavanagh, J., Barry, S. J.E., Der, G., Sattar, N., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:BMC Cardiovascular Disorders
Publisher:BioMed Central
ISSN:1471-2261
ISSN (Online):1471-2261
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in BMC Cardiovascular Disorders 14:139
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
599461Exploring the potential role for allostatic load markers in risk assessment of patients presenting with depressive symptomsFrances MairScottish Executive Health Department (SEHHD-CSO)CAF/12/04IHW - GENERAL PRACTICE & PRIMARY CARE