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Depression, stress tied to increased CV death risk in diabetes
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Elevated stress or depression may be linked to an increased risk for acute coronary heart disease or cardiovascular death among people with diabetes, according to results from the REGARDS study.
In the analysis, Doyle M. Cummings, PharmD, FCP, FCCP, of East Carolina University School of Medicine in North Carolina, and colleagues evaluated data from 22,003 adults (4,090 with diabetes; mean age, 64 years) from the REGARDS study. REGARDS is a population-based, prospective, longitudinal cohort study designed to evaluate factors associated with geographic and racial disparities in stroke incidence and mortality, with a particular focus on disproportionate stroke mortality in the southeastern U.S. (the “stroke belt”) in relation to the rest of the country.
In the current analysis, researchers compared the demographic, socioeconomic and CV risk traits of participants with and without diabetes in three categories: those with no comorbid depression and without elevated levels of self-reported stress, those reporting either depressive symptoms or elevated stress levels, and those reporting both depression and high levels of stress. The researchers then compared age-adjusted incidence rates for each type of CV event in participants with and without diabetes in the three categories.
The researchers found that participants with diabetes had a higher prevalence of elevated stress and/or depression (36.8%) compared with those without diabetes (29.5%; P < .001). Fully adjusted models revealed that in participants with diabetes, self-reported depression or elevated stress was associated with a significantly higher incidence of stroke and CV death. This increased incidence was not seen in participants without diabetes.
In participants with diabetes, the existence of one of the behavioral comorbidities increased the risk for CV death by 53% in relation to participants with diabetes without behavioral comorbidities. The presence of both behavioral comorbidities in participants with diabetes increased the risk for CV mortality by 115% in relation to patients with neither depression nor elevated stress, even after adjustment for various demographic and CV risk factors.
Although participants without diabetes but with one or both behavioral comorbidities also showed a trend toward increased risk for CV death compared with neither comorbidity, these increases were much smaller (12% for one and 27% for both) and did not reach statistical significance.
“These findings demonstrate the persistent disparities and negative CV impact of these comorbidities at the population level and suggest the need for more careful integration of behavioral screening and management in primary care settings, where most patients with type 2 diabetes are managed,” the researchers wrote. – by Jennifer Byrne
Disclosure: Cummings reports no relevant financial disclosures.
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