Higher Income Enhances the Association Between Depressive Symptoms and Cardiovascular Disease

Background: There are evidence of intimate partner violence (IPV) and food insecurity (FI) as independent predictors of maternal depressive symptoms. However, there are a dearth of studies that have examined how both IPV and FI influence depressive symptoms. The objective of this study was to determine whether IPV, food insecurity, or the combined effect of experiencing both IPV and FI predicted later onset of maternal depressive symptoms. Method: Data over a nine year time span from Fragile Families and Child Wellbeing study were used for the current study (N=1421). IPV and FI were both measured at three and five years from the child’s birth. IPV was measured using seven items depicting physical and psychological abuse from spouse/partner. Household FI was measured using the 18-item Food Security Module developed by the United States Department of Agriculture. Four mutually exclusive dichotomous variables were created based on IPV and FI experiences. Mothers who experienced IPV at least at one time but did not experience FI were classified as “IPV only”. Mothers who experienced FI at least at one time but did not experience IPV were classified as “FI only”. Mothers who experienced both IPV and FI at least one time were classified as “both IPV and FI”. The final group “never IPV nor FI” did not experience IPV nor FI. Maternal depressive symptoms at year nine was determined using the Composite International Diagnostic Interview Short Form. Covariate adjusted multivariate logistic regression analysis was used to understand the relation between IPV and FI on onset of depressive symptoms. Results: Twenty-seven percent of the study sample experienced both IPV and FI, 63% IPV only, 4% FI only, and 6% never. At year nine 18% of the mothers reported depressive symptoms. Majority of the sample were non-Hispanic black (52%) or Hispanic (23%), married/cohabiting (57%), and with a high school or higher education (76%). After controlling for age, race/ethnicity, education, marital status, financial strain and prior depressive symptoms, mothers who experienced both IPV and FI during 3-5 years after child’s birth had significantly higher odds of having depressive symptoms at 9 years after child’s birth (OR=2.10, 95% CI: 1.04, 4.27) compared to mothers experiencing neither. The odds of having depressive symptoms among mothers experiencing either IPV only (OR=1.33, 95% CI: 0.67, 2.66) or FI only (OR=2.34, 95% CI: 0.94, 5.86) was not significantly different from mothers experiencing neither. Conclusions: Maternal cumulative experiences of IPV and FI three to five years after child’s birth increased the likelihood of later onset of depressive symptoms. Currently IPV, food insecurity and depression are typically addressed in isolation. Using a trauma-informed approach, combining IPV counselling with public/private food assistance programs might be effective in preventing maternal depressive symptoms later in life.

Elevated NT-ProBNP as a Cardiovascular Disease Risk Equivalent: Evidence from the Atherosclerosis Risk in Communities (ARIC) Study

This study aimed to examine the influence of leisure-time physical activity habits and willingness to engage in physical activity on the onset of depressive symptoms among older adults over a 3-year period. This study included 3341 participants without depressive symptoms who participated in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. Leisure-time physical activity habits and willingness to engage in leisure-time physical activity were elicited using a questionnaire, and the participants were classified into (1) habitual, (2) no habit but willing (willing), and (3) no habit and unwilling (unwilling). Outcome was defined as a score of 6 or more on the Geriatrics Depression Scale in a follow-up survey conducted 3 years after the onset of depressive symptoms. Logistic regression analysis was used to examine the effects of habit and willingness on the onset of depressive symptoms. Of the participants (median age 70 years [interquartile range: 66-76 years]; 56.0% were women), 275 (14.1%) developed depressive symptoms. The habitual, willing, and unwilling groups comprised 2879 (87.2%), 246 (7.5%), and 176 (5.3%), respectively. Logistic regression analysis showed that compared to the habit group, the willing group was significantly associated with the onset of depressive symptoms (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.10-2.78), while the unwilling group was not significantly associated with the onset of depressive symptoms (OR 0.99, 95% CI 0.54-1.82). The gap between the willingness to exercise and the lack of a daily habit can increase the risk of depression in older adults.

Introduction: Treatment of patients with type 2 diabetes mellitus (T2DM) and a history of cardiovascular (CV) disease or CV risk factors may present clinical challenges due to the presence of comorbid conditions and use of concomitant medications. Canagliflozin (CANA), an SGLT2 inhibitor, has been shown to improve glycemic control, body weight, and blood pressure (BP) with a favorable tolerability profile in a broad range of patients with T2DM. This post hoc analysis assessed the efficacy and safety of CANA in patients with T2DM based on CV disease history/risk factors. Methods: These analyses were based on pooled data from four 26-week, placebo (PBO)-controlled, Phase 3 studies that evaluated CANA 100 and 300 mg in patients with T2DM (N = 2313; mean A1C, 8.0%; body weight, 89 kg; systolic BP [SBP], 128 mmHg). Changes from baseline in A1C, body weight, and SBP at Week 26 were assessed in subgroups of patients based on history of CV disease (Y/N), history of hypertension (Y/N), baseline statin use (Y/N), and number of CV risk factors (0/1 vs ≥2). Safety was based on adverse event (AE) reports. Results: CANA 100 and 300 mg lowered A1C, body weight, and SBP versus PBO in patients with or without CV disease history/risk factors ( Table ). At Week 26, A1C reductions with CANA 100 and 300 mg relative to PBO were generally similar in patients with history of CV disease (–0.95% and –1.07%) versus no CV disease (–0.71% and –0.90%), history of hypertension (–0.72% and –0.89%) versus no hypertension (–0.73% and –0.95%), baseline statin use (–0.77% and –0.99%) versus no statin use (–0.69% and –0.85%), and ≥2 CV risk factors (–0.74% and –1.02%) versus 0/1 CV risk factor (–0.72% and –0.87%). Similar body weight and SBP reductions were also seen with CANA versus PBO across subgroups. Incidence of AEs, AEs leading to discontinuation, and serious AEs was similar across subgroups. Conclusions: CANA was efficacious and generally well tolerated in patients with T2DM regardless of CV disease history/risk factors.

Background. Diabetes increases the risk for depression.Aim. To study the independent effects of diabetes mellitus (DM) and cardiovascular disease (CVD) on the prevalence of depression and to examine low birth weight as a possible common explanatory factor.Methods. 2003 subjects from the Helsinki Birth Cohort Study underwent a 75‐g oral glucose tolerance test and filled out the Beck Depression Inventory.Results. Depressive symptoms were more prevalent among subjects with diabetes (23.5%) than among those with normal glucose tolerance (16.6%) (P<0.001). A history of CVD also markedly increased the odds of having depressive symptoms (odds ratio (OR) = 2.38, 95% confidence interval (CI) = 1.70–3.32, P<0.001). The association between DM and depressive symptoms was, however, rendered non‐significant when adjusting for the presence of CVD. Being born with a low birth weight doubled the risk for having depressive symptoms (OR = 2.64, 95% CI = 1.42–4.91, P = 0.002) and magnified the association between CVD/DM and depression.Conclusion. Diabetes has only a minor independent effect on concurrent occurrence of depressive symptoms, while cardiovascular disease seems to be a more important underlying factor. The association between disease and depression is in particular characteristic to individuals born with a low birth weight.

The FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes with optimized renin-angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and cardiovascular outcomes. We report the effect of finerenone on individual cardiovascular outcomes and in patients with and without history of atherosclerotic cardiovascular disease (CVD). This randomized, double-blind, placebo-controlled trial included patients with type 2 diabetes and urine albumin-to-creatinine ratio 30 to 5000 mg/g and an estimated glomerular filtration rate ≥25 to <75 mL per min per 1.73 m2, treated with optimized renin-angiotensin system blockade. Patients with a history of heart failure with reduced ejection fraction were excluded. Patients were randomized 1:1 to receive finerenone or placebo. The composite cardiovascular outcome included time to cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. Prespecified cardiovascular analyses included analyses of the components of this composite and outcomes according to CVD history at baseline. Between September 2015 and June 2018, 13 911 patients were screened and 5674 were randomized; 45.9% of patients had CVD at baseline. Over a median follow-up of 2.6 years (interquartile range, 2.0-3.4 years), finerenone reduced the risk of the composite cardiovascular outcome compared with placebo (hazard ratio, 0.86 [95% CI, 0.75-0.99]; P=0.034), with no significant interaction between patients with and without CVD (hazard ratio, 0.85 [95% CI, 0.71-1.01] in patients with a history of CVD; hazard ratio, 0.86 [95% CI, 0.68-1.08] in patients without a history of CVD; P value for interaction, 0.85). The incidence of treatment-emergent adverse events was similar between treatment arms, with a low incidence of hyperkalemia-related permanent treatment discontinuation (2.3% with finerenone versus 0.8% with placebo in patients with CVD and 2.2% with finerenone versus 1.0% with placebo in patients without CVD). Among patients with chronic kidney disease and type 2 diabetes, finerenone reduced incidence of the composite cardiovascular outcome, with no evidence of differences in treatment effect based on preexisting CVD status. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02540993.

Treating the Black Hypertensive in 2010: Achieve Lower Targets While Awaiting More Definitive Evidence

Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults.Methods: The study sample came from 1992–2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51–61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan–Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity.Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17–1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose–response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant.Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.

Aims To explore the predictive and explanatory factors on the incidence of cardiovascular disease and the impact of visit-to-visit variability (VVV) of risk factors on incident cardiovascular disease in people with type 2 diabetes with no history of prior cardiovascular disease. Methods We performed a historical cohort study (2008-2011) on 481 people with type 2 diabetes and no history of cardiovascular disease. Cardiovascular risk factors were assessed at baseline and repeatedly during follow-up. The predictive analysis included the variables at enrollment, and explanatory analyses were based on mean of the variables measured repeatedly. VVV of the main variables was measured using the standard deviation and coefficient of variation of the measured variables. Separate multivariate binary logistic models were constructed for each parameter with the incident cardiovascular disease. Results Mean age of the participants was 54.9 years, mean glycated hemoglobin was 56 mmol/mol, and mean blood pressure was 125/78 mmHg. Incident cardiovascular disease developed in 14.3% of the participants. The 2-h post breakfast blood glucose was associated with incident cardiovascular disease (odds ratio 1.44; confidence interval = 1.08-1.90; p = 0.01). For each 1 mmol/l increase in postprandial glucose there was a 44% increase in risk of incident cardiovascular disease. VVV of glycemic indices, blood pressure, lipids, body mass index and creatinine were not associated with occurrence of cardiovascular events. Conclusion In this population of patients with type 2 diabetes and no history of cardiovascular disease in whom other cardiovascular risk factors are within or near to the recommended targets, 2-h post breakfast blood glucose level is associated with incident cardiovascular disease.

ObjectiveTo examine separate and joint associations between pre-existing cardiometabolic comorbidities and all cause and cause specific mortality in adults with cancer.DesignMultinational cohort study.SettingSeven European countries from the European Prospective Investigation...

Objective The present study aimed to explore the effects of sense of coherence (SOC) on depressive symptoms after employment in the Japan Self-Defense Force among male young adults.Methods In April 2013, 953 new male members of the Japan Ground Self-Defense Force (JGSDF; age range: 18-24 years) participated in this study. Depressive symptoms were assessed using the 20-item version of the Center for Epidemiologic Studies Depression scale (CES-D), which defines a score of 16 or greater as indicating the presence of depressive symptoms. The SOC score was assessed using a 13-item version (SOC-13), in which a score of 59 or greater is as assigned to the high score group. A second survey was conducted two months later, in June of 2013. For the analysis, we selected participants without depressive symptoms at the baseline survey. The association between SOC scores at baseline and the onset of depressive symptoms was examined using a logistic regression analysis.Results The final analysis was conducted on data on 389 new male members of the JGSDF. The logistic regression analysis showed a significant reduction in the onset of depressive symptoms among the group with high SOC scores (odds ratios: 0.59, 95% confidence interval=0.35-0.98) as compared with that observed in the group with low SOC scores.Conclusions The present study clarified that SOC among male young adults has a buffering effect on the risk of developing depressive symptoms after employment in the Japan Self-Defense Force. Our results may be useful for improving the mental health of new employees.

Biological evidence suggests that vitamin D might be involved in regulating mood. The relationship between 25-hydroxyvitamin D (25OHD) and the onset of depressive symptoms was examined over a 4.4-year follow-up in a sample of older adults. This research was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study on a total of 1,039 women and 636 men aged 65 and older. Serum 25OHD levels were measured at baseline. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) at the baseline and during the follow-up. Analyses were adjusted for relevant confounders, including health and performance status. 25OHD levels correlated inversely with baseline GDS scores, but only in women. After controlling for confounders, women deficient in vitamin D (25OHD < 50 nmol/L) had higher GDS scores than those who were replete (25OHD > 75 nmol/L), with mean [SE] GDS scores: 9.57 [0.37] vs 8.31 [0.31], respectively, p = .02. In men, the relationship between 25OHD levels and baseline GDS scores was no longer significant after controlling for covariates. Adjusted hazard ratios and 95% confidence intervals for incident depression in participants who were vitamin D deficient vs replete were not statistically significant (hazard ratio: 0.74, 95% confidence interval [0.47-1.16] in women; hazard ratio: 0.96 95% confidence interval [0.45-2.06] in men). Although an independent inverse association between 25OHD levels and GDS scores emerged for women on cross-sectional analysis, vitamin D deficiency showed no direct effect on the onset of late-life depressive symptoms in our prospectively studied population. Further studies are warranted to clarify the potential influence of vitamin D on psychological health.

Background Depression was found to increase the risk of cardiovascular disease (CVD). In terms of CVD prevention in people with depressive symptoms, the main goal is to successfully control classic CVD risk factors. Aims: The aim of the study was to assess the relationship between depression and 1) the frequency of healthcare utilization, 2) counseling on main CVD risk factors during usual medical visits, 3) compliance with pharmacotherapy in primary and secondary prevention. Methods WOBASZ II was a cross‑sectional study targeting a representative sample of the Polish population. Trained nurses obtained information on depression (using the Beck Depression Inventory), education, healthcare utilization, counseling on CVD risk factors, and compliance with the recommended pharmacotherapy. Results As many as 5531 participants completed the Beck Depression Inventory questionnaire and provided information on CVD. After adjustment for age, sex, and education, participants without CVD but with depression had blood pressure measured slightly more often and received more frequent counseling on: nutrition (40% more), physical activity (43% more), and smoking cessation (nearly 30% more). Counseling on main CVD risk factors during typical visits and compliance with the recommended pharmacotherapy did not differ with regards to depression in patients with a history of CVD. Conclusions The recommendations from the European Society of Cardiology for particularly careful control of CVD risk factors in people with depression are to some extent reflected in primary prevention. The relationship between depression and counseling on CVD risk factors in patients with CVD was insignificant. Compliance with the recommended pharmacotherapy was not related to depression.

To investigate glucose-lowering treatment trajectories preceding glucagon-like peptide-1 receptor agonist (GLP-1RA) initiation in UK primary care, while assessing alignment with contemporary UK clinical guidelines, considering calendar time, cardiovascular disease (CVD) history, and obesity status. Using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, a Cegedim Database, we included adults with type 2 diabetes initiating GLP-1RAs in UK primary care between 01 January 2007 and 30 June 2023. We described treatment trajectories from the first glucose-lowering therapy to GLP-1RA initiation, stratified by calendar time (GLP-1RA initiation pre- or post-01 January 2018, when guidelines started recommending sodium-glucose co-transporter-2 inhibitors [SGLT-2is] for those at high risk or established CVD), CVD history, and body mass index (BMI) ≥35 kg/m2. We included 29 780 GLP-1RA initiators, with 62.2% (n = 18 517) initiating pre-2018 and 37.8% (n = 11 263) post-2018. Consistent over calendar time, most GLP-1RA initiators (63.5%) received their first GLP-1RA as fourth-line (35.4%) or later-line therapy (28.1%), with fewer initiating GLP-1RAs as first- (0.8%), second- (10.5%), or third-line (25.2%) treatments. After 2018, 50.8% of individuals initiating GLP-1RA therapy used SGLT-2is concomitantly, regardless of CVD status (47.8% with established CVD vs. 51.5% without). Individuals with BMI ≥35 kg/m2 initiated GLP-1RA therapy earlier compared to those with BMI <35 kg/m2 (46.3% vs. 29.1% as first-, second-, or third-line treatment). GLP-1RAs were predominantly initiated following ≥3 glucose-lowering agents, consistent with contemporary UK guidance (NG28). Post-2018, most GLP-1RA initiators received SGLT-2is concomitantly. However, CVD history did not influence prescribing patterns, underscoring missed opportunities to optimise the prevention of cardiovascular events and slow the progression of CVD.

Background: Personality traits, such as neuroticism, that results in vulnerability to stress, and resilience, a measure of stress coping, are closely associated with the onset of depressive symptoms, whereas regular physical activity habits have been shown to reduce depressive symptoms. In this study, the mediating effects of neuroticism and resilience between physical activity duration and depressive symptoms were investigated by a covariance structure analysis. Methods: Between April 2017 and April 2018, 526 adult volunteers were surveyed using self-administered questionnaires. Demographic information, habitual physical activity duration (PAD), neuroticism, and resilience were investigated. The effects of these factors on depressive symptoms were analyzed by a covariance structure analysis. This study was conducted with the approval of the Medical Ethics Committee of Tokyo Medical University. Results: The dose–response curves of physical activity duration and depression scores were U-shaped: the optimal physical activity duration for the lowest depression score was 25.7 h/week. We found that the greater the difference from the optimal PAD, the higher the neuroticism and the lower the resilience, and the more severe the depressive symptoms. Covariance structure analysis demonstrated that neuroticism and resilience significantly and completely mediated the effects of the difference from the optimal PAD on depressive symptoms (coefficient of determination R2 = 0.349). Conclusion: Our study suggests that there is an optimal PAD that reduces depressive symptoms, and that a greater difference from the optimal PAD increases depressive symptoms through neuroticism and resilience.