J Psychiatry Neurosci 2018;43(2):111-119
Veronica Onete, MD, PhD; Ronald M. Henry, MD, PhD; Simone J.S. Sep, PhD; Annemarie Koster, PhD; Carla J. van der Kallen, PhD; Pieter C. Dagnelie, PhD; Nicolaas Schaper, MD, PhD; Sebastian Köhler, PhD; Koen Reesink, PhD; Coen D.A. Stehouwer, MD, PhD; Miranda T. Schram, PhD
Background: Arterial stiffening may underlie the association between depression and cardiovascular disease (CVD), but reported data are inconsistent. We investigated the associations between aortic stiffness and major depressive disorder (MDD) and depressive symptoms, and whether these differed by sex and age.
Methods: We measured carotid to femoral pulse wave velocity (cfPWV) using applanation tonometry, and we assessed depression using the Mini-International Neuropsychiatric Interview (MINI) and the Patient Health Questionnaire-9 (PHQ-9) in a cohort of participants from The Maastricht Study. Logistic and negative binominal models were adjusted for age, type 2 diabetes mellitus (T2DM), mean arterial pressure (MAP) and CVD risk factors.
Results: We included 2757 participants in our analyses (48.8% men, mean age 59.8 ± 8.1 yr, 27% T2DM). We found that cfPWV was associated with MDD in men (fully adjusted odds ratio [OR] 2.36, 95% confidence interval [CI] 1.45–3.84), but not in women (OR 1.57, 95% CI 0.93–2.66), aged 60 years or younger. The ORs were not significant in individuals older than 60 years (men: OR 1.03, 95% CI 0.63–1.68; women: OR 0.64, 95% CI 0.32–1.31). Similarly, cfPWV was associated with a higher PHQ-9 score in men (rate ratio 1.28, 95% CI 1.09–1.52), but not in women (rate ratio 1.11, 95% CI 0.99–1.23), aged 60 years or younger. Associations were not significant in individuals older than 60 years (men: rate ratio 0.96, 95% CI 0.84–1.08; women: rate ratio 1.00, 95% CI 0.90–1.12).
Limitations: We cannot rule out reversed causation in this cross-sectional study.
Conclusion: Greater aortic stiffness is associated with MDD and depressive symptoms among middle-aged men and to a lesser extent in women, whereas this association was not observed in old age.
Submitted Dec. 23, 2016; Revised Apr. 25, 2017; Accepted Aug. 1, 2017; Online first Oct. 10, 2017
Affiliations: From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
Competing interests: None declared.
Contributors: V. Onete, S. Sep, A. Koster, P. Dagnelie, N. Schaper, C. Stenhouwer and M. Schram designed the study. V. Onete, C. van der Kallen, S. Köhler and K. Reesink acquired the data, which V. Onete, R. Henry, C. Stenhouwer and M. Schram analyzed. V. Onete, C. Stenhouwer and M. Schram wrote the article, which all authors critically reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: M.T. Schram, The Maastricht Study, Department of Medicine, Maastricht University Medical Center, Randwycksingel 35, 6229 EG Maastricht, The Netherlands; firstname.lastname@example.org