Association between arterial stiffness, depression mediated by metabolic syndrome, inflammation

Future cardiovascular risk among adult patients with depression may be identifiable early using combined data on metabolic syndrome and inflammation, according to results of a population-based cohort study published in JAMA Psychiatry. Researchers used this data to determine that one-third of the association of depression with elevated arterial stiffness index levels during midlife may be accounted for by combined inflammatory and metabolic syndrome processes.

“Although the systematic assessment of [arterial stiffness index (ASI)] in the general population is not currently recommended, it represents a promising screening tool to discriminate among subgroups at mild to moderate risk for future [major cardiovascular events],” Alex Dregan, PhD, of the department of psychological medicine at King’s College London, and colleagues wrote. “Our study findings identified that one-third of the proportion of the association between depression and ASI, and consequently, the risk for [major cardiovascular events], may be potentially prevented by addressing the combined effects of [metabolic syndrome] and inflammation.”

According to the researchers, a link between history of depression and arterial stiffness has been determined in prior research. In the present study, they assessed the association of depression with elevated midlife arterial stiffness to investigate the role of metabolic syndrome in this association. They collected data from 124,445 participants aged 40 to 69 years who were included in the United Kingdom Biobank and excluded participants without baseline data on arterial stiffness or those who reported a previous diagnosis of cardiovascular disease. They used verbal interview and linked hospital-based clinical depression diagnosis to assess lifetime history of depression. They defined metabolic syndrome as the presence of three or more of unhealthy waist circumference, hypertension, dyslipidemia, hyperglycemia and hypertriglyceridemia.

Dregan and colleagues found that among 124,445 participants with ASI data, 10,304 reported a history of depression, and their findings showed a direct association between depression and ASI levels (beta = 0.25; 05% CI, 0.17-0.32). This indicated that 29% of the association of depression with ASI was mediated by metabolic syndrome, they noted. When C-reactive protein was added to the metabolic syndrome criteria, the proportion of mediation increased to 37%. Regarding components of metabolic syndrome, the strongest indirect association was for waist circumference, which accounted for 25% of the association between ASI levels and depression. Hypertriglyceridemia accounted for 19% of this association among men.

The researchers noted that their suggestion of addressing the combined effects of metabolic syndrome and inflammation in this patient population “is contingent on the effective implementation of complex interventions (with several interacting components) targeting multiple [metabolic syndrome] and inflammatory processes at the population level.” – by Joe Gramigna

Disclosures: Dregan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.