Highlights
- •We studied anxiety/depression symptoms/diagnoses and CIMT in ELSA-Brasil baseline.
- •More anxiety/depression symptoms were associated with higher CIMT values.
- •Common mental disorder was associated with higher CIMT for the same age, sex and race.
- •Generalized anxiety disorder was associated with higher CIMT after multivariate adjustment.
Abstract
Background
Studies focusing on the association between anxiety/depressive symptoms and accelerated
subclinical atherosclerosis have yielded mixed results. Our aim is to examine associations
between anxiety/depressive symptoms, common mental disorder (CMD), major depression
disorder (MDD) or generalized anxiety disorder (GAD) and carotid intima-media thickness
(CIMT) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline.
Methods
The ELSA-Brasil baseline assessment included CIMT measurements and the Clinical Interview
Schedule – Revised (CIS-R), a validated questionnaire for anxiety/depressive symptoms/diagnoses.
We analyzed participants without previous coronary heart disease or stroke, and with
high-quality CIMT images. We built regression models to determine whether the CIS-R
score, CMD, MDD or GAD were associated with maximal CIMT levels.
Results
The study sample comprised 9744 participants. We found that individuals with higher
CIS-R scores (Odds ratio for one standard deviation increase [OR]:1.12; 95% confidence
interval [95%CI]:1.06–1.19), CMD (OR:1.22; 95%CI:1.07–1.38) and GAD (OR:1.19; 95%CI:1.01–1.41)
had significantly higher odds of being classified in the highest age, sex and race-specific
CIMT quartile. In the linear models, after adjustment for traditional cardiovascular
risk factors, higher CIS-R scores (β:0.005; P = 0.010) and GAD (β:0.010; P = 0.049)
were independently associated with CIMT values.
Conclusion
Individuals with more symptoms of anxiety and/or depression, or diagnoses of CMD or
GAD, had higher CIMT values, compared to peers of same age, sex and race. CIS-R scores
and GAD were independently associated with higher CIMT values. These results suggest
an association between anxiety/depressive symptoms (and, most notably, GAD) and accelerated
subclinical atherosclerosis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mental disorders in megacities: findings from the São Paulo megacity mental health survey, Brazil.PLoS One. 2012; 7: e31879
- Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006.Prev Med. 2008; 46: 445-450
- The association between mood and anxiety disorders, and coronary heart diseasein Brazil: a cross-sectional analysis on the Brazilian longitudinal study of adult health(ELSA-Brasil).Front. Psychol. 2015; 25: 187
- Cardiovascular risk in individuals with depression.Rev. Da Assoc. Medica Bras. 2013; 59: 298-304
- Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany.Cerebrovasc. Dis. 2004; 2012 (Brussels, Belgium, 2006, and Hamburg, Germany, 2011): 290-296
- Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.Circulation. 2007; 115: 459-467
- Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American society of echocardiography carotid intima-media thickness task force. Endorsed by the society for vascular medicine.J. Am. Soc. Echocardiogr. 2008; 21 (93-111; quiz): 189-190
- Relation between depressive symptoms and common carotid artery atherosclerosis in American persons > or =65 years of age.Am. J. Cardiol. 2007; 99: 1610-1613
- Depressive symptoms and sub-clinical atherosclerosis in Africans: role of metabolic syndrome, inflammation and sympathoadrenal function.Physiol. Behav. 2011; 104: 744-748
- Association between depression and intima-media thickness of carotid bulb in asymptomatic young adults.Am. J. Med. 2009; 122: e1151-e1158
- Gender differences in the association between depressive symptoms and carotid atherosclerosis among middle-aged and older Koreans: the namwon study.J. Korean Med. Sci. 2014; 29: 1507-1513
- Depression symptoms and the progression of carotid intima-media thickness: a 5-year follow-up study.Atherosclerosis. 2014; 233: 530-536
- Association of depression with common carotid artery intima media thickness and augmentation index in a large urban South Indian population- the Chennai urban rural Epidemiology Study (CURES – 138).Indian J. Endocrinol. Metab. 2015; 19: 136-142
- Negative emotions and 3-year progression of subclinical atherosclerosis.Arch. Gen. Psychiatry. 2007; 64: 225-233
- Relationship between atherosclerosis and late-life depression. The rotterdam study.Arch. Gen. Psychiatry. 2004; 61: 369-376
- History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg health study.Psychol. Med. 2014; 44: 919-925
- Depressive symptoms and carotid intima-media thickness in South American hispanics: results from the prevencion study.J. Behav. Med. 2015; 38: 284-293
- Depressive symptoms and carotid artery intima-media thickness in young adults: the cardiovascular risk in young finns study.Psychosom. Med. 2005; 67: 561-567
- Lifetime history of depression and carotid atherosclerosis in middle-aged women.Arch. Gen. Psychiatry. 2003; 60: 153-160
- Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis.Psychosom. Med. 2012; 74: 517-525
- Depressive symptoms and carotid artery intima-media thickness in police officers.Int. Arch. Occup. Environ. Health. 2013; 86: 931-942
- Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women?.Psychosom. Med. 1998; 60: 633-638
- Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong.Maturitas. 2010; 67: 186-191
- Sustained anxiety and 4-year progression of carotid atherosclerosis.Arterioscler. Thromb. Vasc. Biol. 2001; 21: 136-141
- Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design.Am. J. Epidemiol. 2012; 175: 315-324
- Cohort profile: longitudinal study of adult health (ELSA-Brasil).Int. J. Epidemiol. 2015; 44: 68-75
- Medical assessments and measurements in ELSA-Brasil.Rev. Saude Publica. 2013; 47: 54-62
- Carotid intima-media thickness value distributions in the Brazilian longitudinal study of adult health (ELSA-Brasil).Atherosclerosis. 2014; 237: 227-235
- Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group.N. Engl. J. Med. 1999; 340: 14-22
- Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men.Stroke. 2004; 35: 2788-2794
- Carotid intima-media thickness at different sites: relation to incident myocardial infarction; the rotterdam study.Eur. Heart J. 2002; 23: 934-940
- Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers.Psychol. Med. 1992; 22: 465-486
- International Statistical Classification of Diseases and Related Health Problems.World Health Organization, Geneva1992: 3
- Cross-cultural adaptation of CIS-R (clinical interview schedule-revised version) for portuguese in longitudinal study of adult health (ELSA).Rev. HCPA. 2011; 31: 487-490
- Depression and body mass index, a u-shaped association.BMC Public Health. 2009; 9: 14
- Depression and anxiety among US adults: associations with body mass index.Int. J. Obes. (Lond). 2009; 33: 257-266
- ATC/DDD Index 2014.in: WHO Collaborating Center for Drug Statistics and Methodology. 2014
- Patterns of benzodiazepine and antidepressant use among middle-aged adults. The Brazilian longitudinal study of adult health (ELSA-Brasil).J. Affect Disord. 2013; 151: 71-77
- Computing, R. F. F. S R: a Language and Environment for Statistical Computing. Austria, Vienna2011
- Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies.Eur. Heart J. 2006; 27: 2763-2774
- Anxiety and risk of incident coronary heart disease: a meta-analysis.J. Am. Coll. Cardiol. 2010; 56: 38-46
- Depression and cardiovascular disease: a clinical review.Eur. Heart J. 2014; 35: 1365-1372
- The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults.Gen. Hosp. Psychiatry. 2008; 30: 127-137
- Depression and the metabolic syndrome in young adults: findings from the third national health and nutrition examination survey.Psychosom. Med. 2004; 66: 316-322
- Platelets and depression in cardiovascular disease: a brief review of the current literature.World J. Psychiatry. 2012; 2: 114-123
- Depression in coronary artery disease: novel pathophysiologic mechanisms and therapeutic implications.Int. J. Cardiol. 2007; 116: 153-160
- Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study.Arch. Gen. Psychiatry. 2009; 66: 617-626
- Positive affect dimensions and their association with inflammatory biomarkers in patients with chronic heart failure.Biol. Psychol. 2013; 92: 220-226
- The relationship between mental and physical health: insights from the study of heart rate variability.Int. J. Psychophysiol. 2013; 89: 288-296
- Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia.Proc. Natl. Acad. Sci. U. S. A. 2005; 102: 8303-8308
- Measuring anxiety: are we getting what we need?.Depress Anxiety. 2005; 22: 1-10
- Self-report and clinician-rated measures of depression severity: can one replace the other?.Depress Anxiety. 2012; 29: 1043-1049
- Depressive and anxiety disorders and risk of subclinical atherosclerosis findings from the Netherlands Study of depression and anxiety (NESDA).J. Psychosom. Res. 2010; 69: 203-210
- Depressive symptoms are related to progression of coronary calcium in midlife women: the study of women's health across the nation (SWAN) heart study.Am. Heart J. 2011; 161 (e1181): 1186-1191
- Psychosocial factors and coronary calcium in adults without clinical cardiovascular disease.Ann. Intern Med. 2006; 144: 822-831
- Association of depressive symptoms, trait anxiety, and perceived stress with subclinical atherosclerosis: results from the Chicago healthy aging study (CHAS).Prev. Med. 2014; 61: 54-60
- Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk.PLoS One. 2012; 7 (e30777)
- Effects of depression, anxiety, comorbidity, and antidepressants on resting-state heart rate and its variability: an ELSA-Brasil cohort baseline study.Am. J. Psychiatry. 2014; 171: 1328-1334
- Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of disease study 2013.Lancet. 2015; 385: 117-171
- Quality of medical care and excess mortality in older patients with mental disorders.Arch. Gen. Psychiatry. 2001; 58: 565-572
- Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.Arch. Intern Med. 2000; 160: 2101-2107
- Does evidence support the American heart association's recommendation to screen patients for depression in cardiovascular care? an updated systematic review.PLoS One. 2013; 8 (e52654)
- Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument.Rev. Saude Publica. 2013; 47: 27-36
- Carotid intima-media thickness in individuals with and without type 2 diabetes: a reproducibility study.Cardiovasc Diabetol. 2010; 9: 40
- Variability and reproducibility of carotid structural and functional parameters assessed with transcutaneous ultrasound – results from the SAPALDIA cohort study.Atherosclerosis. 2013; 231: 448-455
Article info
Publication history
Published online: April 25, 2015
Accepted:
April 20,
2015
Received in revised form:
April 9,
2015
Received:
February 24,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
