Depression Linked to Arterial Stiffness and Metabolic Syndrome


Investigators link waist circumference with an increased risk of depression for patients with arterial stiffness.

Elevated arterial stiffness levels is tied to an increased risk of depression for patients with metabolic syndrome.

A team, led by Alex Dregan, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, examined the link between depression and arterial stiffness mediated by metabolic syndrome.

Previously, investigators have tied patients with a history of depression with arterial stiffness during midlife. Patients with depression are generally at an increased risk of major cardiovascular events, including coronary heart disease and stroke.

Arterial stiffness is the hardening of the artery wall due to aging and diverse pathologic states and can be a mediator of a major cardiovascular event.

The population-based cohort study included 124,445 patients between 40-69 years old who participated in the UK Biobank. Patients without data on arterial stiffness at baseline or who reported a previous diagnosis of cardiovascular disease were not eligible.

The investigators found the addition of inflammation to metabolic syndrome further increased the proportion of the mediated association of depression with arterials stiffness and combining data on metabolic syndrome and inflammation could improve the early identification of future cardiovascular risk among adult patients with depression.

The team assessed a lifetime history of depression through a verbal interview and linked hospital-based clinical depression diagnosis. They defined metabolic syndrome as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hyper triglyceridemia, and unhealthy waist circumference.

In the large cohort study, 10,304 patients reported a history of depression. The investigators discovered a significant direct association between depression and arterials stiffness (β = .25; 95% CI, .17-.32), as well as a significant indirect association between depression and arterial stiffness levels (β = .10; 95% CI, .07-.13),


This indicates that 29% of the association of depression with arterial stiffness was mediated by metabolic syndrome. The proportion of mediation increased to 37% when C-reactive protein was added to the metabolic syndrome criteria (direct association: β = .21; 95% CI, .15-.28; indirect association: β = .13; 95% CI, .10-.17).

Particularly, there was the strongest indirect association for waist circumference, accounting for 25% of the association between depression and arterial stiffness levels (direct association: β = .26; 95% CI, .18-.34; indirect association: β = .09; 95% CI, .06-.11).

For men, hypertriglyceridemia accounted for 19% of the association between depression and arterial stiffness (direct association: β = .22; 95% CI, .05-.40; indirect association: β = .05; 95% CI, .02-.08).

“One-third of the association of depression with elevated [arterial stiffness] levels during midlife may be accounted for by combined [metabolic syndrome] and inflammatory processes,” the authors wrote. “Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.”

In a 2019 study, investigators found 1 in 5 cardiac rehabilitation patients suffered from depression, highlighting the need for monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation to assist with improving adherence.

In an attempt to evaluate and assess the prevalence and impact of depression and anxiety on patients in cardiac rehabilitation, investigators from the University of Technology Sydney designed a retrospective cohort study of patients who entered rehabilitation programs from 2006 to 2016. Investigators obtained data on a cohort of 5908 patients from 2 Sydney metropolitan teaching hospitals.

Analyses revealed adults with moderate depression (24% versus 13%), anxiety (32% versus 23%), or stress symptoms (18% versus 10%) were significantly less likely to adhere to cardiac rehabilitation compared to those without such symptoms. Anxiety (OR, 4.395; 95% CI, 3.363—5.744; P <.001) and stress (OR, 4.527; 95% CI, 3.315—6.181; P <.001) were the strongest predictors of depression observed during the study period.

Similarly, the presence of depression (OR, 3.167; 95% CI, 2.411—4.161) and stress (OR, 5.577; 95% CI, 4.006–7.765; P <.001) increased the risk of anxiety on entry more than the risk incurred by socio-demographic factors, cardiovascular risk factors, diagnoses, and quality of life.

The study, “Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study,” was published online JAMA Psychiatry.

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