Symptoms of depression and impaired endothelial function in healthy adolescent women

A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease

PURPOSE OF REVIEW

Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption.

RECENT FINDINGS

Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in MAGI-1 are also linked to chronic inflammatory disorders such as spontaneous glomerulosclerosis, celiac disease, ulcerative colitis, and Crohn's disease. Increased MAGI-1 expression has been observed in colonic epithelial samples from Crohn's disease and ulcerative colitis patients. MAGI-1 also plays a role in regulating EC activation and atherogenesis in mice and is essential for Influenza A virus (IAV) infection, endoplasmic reticulum stress-induced EC apoptosis, and thrombin-induced EC permeability. Despite being understudied in human disease; evidence suggests that MAGI-1 may play a role in linking CVD and MDD. Therefore, further investigation of MAG-1 could be warranted to elucidate its potential involvement in these conditions.

Arsenic exposure from drinking water and endothelial dysfunction in Bangladeshi adolescents

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, with ∼80% of CVD-related deaths occurring in low- and middle-income countries. Growing evidence suggests that chronic arsenic exposure may contribute to CVD through its effect on endothelial function in adults. However, few studies have examined the influence of arsenic exposure on cardiovascular health in children and adolescents. To examine arsenic's relation to preclinical markers of endothelial dysfunction, we enrolled 200 adolescent children (ages 15-19 years; median 17) of adult participants in the Health Effects of Arsenic Longitudinal Study (HEALS), in Araihazar, Bangladesh. Participants' arsenic exposure was determined by recall of lifetime well usage for drinking water. As part of HEALS, wells were color-coded to indicate arsenic level (<10 μg/L, 10-50 μg/L, >50 μg/L). Endothelial function was measured by recording fingertip arterial pulsatile volume change and reactive hyperemia index (RHI) score, an independent CVD risk factor, was calculated from these measurements. In linear regression models adjusted for participant's sex, age, education, maternal education, land ownership and body weight, individuals who reported always drinking water from wells with >50 μg/L arsenic had a 11.75% lower level of RHI (95% CI: -21.26, -1.09, p = 0.03), as compared to participants who drank exclusively from wells with ≤50 μg/L arsenic. Sex-stratified analyses suggest that these associations were stronger in female participants. As compared to individuals who drank exclusively from wells with ≤50 μg/L arsenic, the use of wells with >50 μg/L arsenic was associated with 14.36% lower RHI (95% CI: -25.69, -1.29, p = 0.03) in females, as compared to 5.35% lower RHI (95% CI: -22.28, 15.37, p = 0.58) in males for the same comparison. Our results suggest that chronic arsenic exposure may be related to endothelial dysfunction in adolescents, especially among females. Further work is needed to confirm these findings and examine whether these changes may increase risk of later adverse cardiovascular health events.

Low-grade inflammation and endothelial dysfunction predict four-year risk and course of depressive symptoms: The Maastricht study

BACKGROUND

Low-grade inflammation (LGI) and endothelial dysfunction (ED) might play a key role in the development of depression. We investigated the associations and mediation of LGI and ED with four-year incidence and course of depressive symptoms (remitted, recurrent or persistent).

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

In this prospective cohort study (mean age 59.6 ± 8.2 years, 48.9% women, 26.6% diabetes by design), Cox and multinomial regression analyses, adjusted for age, sex, educational level and diabetes status were used to investigate the associations of LGI and ED with onset and course of depressive symptoms as assessed by the PHQ-9 questionnaire.

RESULTS

During 10,847 person-years of follow-up, 264 participants developed incident depression. Higher levels of LGI (OR [95%CI] per SD 1.32[1.16-1.49], p < 0.001) and ED (1.26[1.11-1.43], p < 0.001) were associated with incident depressive symptoms. In mediation analysis, 60% of the total effect of ED with incident depressive symptoms could be attributed to LGI. 76 out of 2637 participants had a persistent course of depressive symptoms. Higher levels of LGI (1.75[1.40-2.19], p < 0.001) and ED (1.33[1.04-1.71], p = 0.021) were associated with a persistent course of depressive symptoms. Higher ED was more strongly associated with persistent depressive symptoms (1.33[1.04-1.71], p = 0.021), while LGI was associated with remission of depression symptoms.

CONCLUSIONS

LGI and ED were both associated with incident depressive symptoms, where the latter association was substantially mediated by LGI. ED was further associated with a persistent course of depressive symptoms, while LGI was not. These results suggest a temporal, vascular contribution of both LGI and ED to the etiology and chronicity of depressive symptoms.

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.

Exposure to household air pollutants and endothelial dysfunction in rural Bangladesh: A cross-sectional study

More than one third of world's population use biomass fuel for cooking that has been linked to an array of adverse health hazards including cardiovascular mortality and morbidity. As part of Bangladesh Global Environmental and Occupational Health (GEO Health) project, we assessed whether household air pollution (HAP) was associated with dysfunction in microvascular circulation (measured by reactive hyperemia index [RHI]).

METHODS

We measured exposure to HAP (particulate matter [PM2.5], carbon monoxide [CO], and black carbon [BC]) for 48 hours of 200 healthy nonsmoker adult females who used biomass fuel for cooking. Exposure to PM2.5 and BC were measured using personal monitor, RTI MicroPEM (RTI International, NC) with an internal filter that had been both pre- and post-weighed to capture the deposited pollutants concentration. Lascar CO logger was used to measure CO. Endothelial function was measured by forearm blood flow dilatation response to brachial artery occlusion using RHI based on peripheral artery tonometry. A low RHI score (<1.67) indicates impaired endothelial function.

RESULTS

Average 48 hours personal exposure to PM2.5 and BC were 144.15 μg/m3 (SD 61.26) and 6.35 μg/m3 (SD 2.18), respectively. Interquartile range for CO was 0.73 ppm (0.62-1.35 ppm). Mean logarithm of RHI (LnRHI) was 0.57 in current data. No statistically significant association was observed for LnRHI with PM2.5 (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.92, 1.01; P = 0.16), BC (OR = 0.85; 95% CI = 0.72, 1.01; P = 0.07), and CO (OR = 0.89; 95% CI = 0.64, 1.25; P = 0.53) after adjusting for potential covariates.

CONCLUSIONS

In conclusion, HAP was not associated with endothelial dysfunction among nonsmoking females in rural Bangladesh who used biomass fuel for cooking for years.

Depression and cardiovascular disease: The deep blue sea of women's heart

Cardiovascular disease (CVD) constitutes a leading worldwide health problem, with increasing evidence of differences between women and men both in epidemiology, pathophysiology, clinical management, and outcomes. Data from the literature suggest that women experience a doubled incidence of CVD related deaths, while angina, heart failure and stroke are increasingly prevalent in females. About 20-25% of women go through depression during their life, and depressive symptoms have been considered a relevant emergent, non-traditional risk factor for CVD in this part of the general population. Underlying mechanisms explaining the link between depression and CVD may range from behavioral to biological risk factors, including sympathetic nervous system hyperactivity and impairment in hypothalamic-pituitary-adrenal function. However, the neuroendocrine-driven background could only partially explain the differences mentioned above for chronic systemic inflammation, altered hemostasis and modulation of cardiac autonomic control. In addition, some evidence also suggests the existence of gender-specific differences in biological responses to mental stress. Given these premises, we here summarize the current knowledge about depression and CVD relationship in women, highlighting the sex differences in physiopathology, clinical presentation and treatments.

Inflammatory and vascular correlates of mood change over 8 weeks

Background

Mood disorders have been associated with a variety of cardiovascular disease risk factors, including inflammation and large artery stiffness, particularly while depressed although longitudinal studies have been limited.

Methods

With measurements at baseline and 8 weeks, the researchers prospectively assessed mood, levels of inflammatory markers (hsCRP and TNF-α), serum lipids, and large artery stiffness in a cohort of 26 participants with a diagnosis of a mood disorder, enriched for current depression. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline and 8 weeks. Associations between depressive symptoms and other measures were assessed using linear mixed models, unadjusted and adjusted for age and BMI.

Results

The mean age of the participants (n=26) was 41.6 (standard deviation [SD] 12.8) years, and 81% were female. During the study, there was a mean (SD) MADRS score improvement of 9.5 (9.4) from baseline to eight weeks. Reductions in the primary outcome TNF-α with improvement in depression fell short of significance (P=0.076). In secondary analyses, there was a statistically significant association between improved cholesterol ratio (P=0.038) and triglycerides (P=0.042) with depression improvement. There was no statistically significant change in large artery stiffness during the study.

Conclusion

Improved depressive symptoms were associated with improved cholesterol ratios even after adjustment, suggesting possible mechanism by which acute mood states may influence cardiovascular disease risk. Future longitudinal studies with extended and intensive follow-up investigating cardiovascular disease risk related to acute changes and persistence of mood symptoms is warranted.

Serotonin Transporter Gene Polymorphism in Women With Suspected Ischemia

Introduction:

Association of serotonin transporter gene ( 5-HTTLPR) polymorphisms with adverse cardiovascular (CV) events in women with suspected ischemia has not yet been reported. We hypothesized an association of 5-HTTLPR polymorphisms with risk of adverse CV events in women with suspected ischemic heart disease (IHD) referred for coronary angiography enrolled in the Women’s Ischemia Syndrome Evaluation (WISE).

Method:

We studied clinical and angiographic data and DNA from a cohort of 437 Caucasian women enrolled in the WISE genotyped for the long (L) and short (S) variant of the 5-HTTLPR polymorphism. Women were followed yearly for adverse CV events (defined as first occurrence of all-cause death, myocardial infarction, stroke, or heart failure hospitalization) with data collected at WISE 10-year follow-up. Exploratory analyses compared outcomes between genotype groups.

Results:

A total of 437 women, with baseline, angiographic, and long-term follow-up data, were successfully genotyped. Their mean age was 58 ± 11 years and body mass index 29 ± 6; 54% had hypertension, 18% diabetes, 50% dyslipidemia, 20% depression history, and only 34% had obstructive CAD. At 8.9 years median follow-up, the SS genotype was associated with significantly increased risk of adverse CV event versus LL + LS (1.93, confidence interval [CI]: 1.03-3.61, P = .03). Results were not significant for all-cause death (hazard ratio: 1.63, CI: 0.91-2.93, P = .09).

Conclusion:

Among a cohort of Caucasian women with suspected IHD enrolled in the WISE, the SS homozygous genotype for the 5-HTTLPR polymorphism was associated with increased risk of adverse CV outcomes.

Do self-reported stress and depressive symptoms effect endothelial function in healthy youth? The LOOK longitudinal study

BACKGROUND AND AIMS

Endothelial dysfunction is thought to be an early indicator of risk for cardiovascular disease and has been associated with both stress and depression in adults and adolescents. Less is known of these relationships in younger populations, where the origins of CVD is thought to manifest. This study examined the effects of questionnaire derived psychosocial stress and depressive symptoms on endothelial function among children, following them through to adolescence.

METHOD

Participants were 203 grade 2 children (111 girls; M age = 7.6 ± 0.3 years) from the LOOK longitudinal study, who were followed through to adolescence (16 years). Self-reported psychosocial stress and depression were assessed using the validated Children's Stress Questionnaire and a modified and validated version of the Children's Depression Inventory respectively; endothelial function was assessed using EndoPAT 2000 system at follow-up only; and adjustments were made for fitness, pubertal development and socioeconomic status.

RESULTS

Although all relationships occurred in the hypothesised direction, no cross-sectional or prospective evidence of early symptoms of psychological stress or depression being associated with endothelial dysfunction was found among our asymptomatic cohort of adolescents (all p > .05).

CONCLUSIONS

In contrast to previous findings in adolescents, our data provided little evidence of any relationship between current or previous psychosocial stress or depression and endothelial function in 16-year-old boys and girls. However, our data need to be interpreted alongside the potential limitations in the sensitivity associated with self-report methods for detecting psychological distress of children.

Polygenic Risk for Depression Increases Risk of Ischemic Stroke: From the Stroke Genetics Network Study

BACKGROUND AND PURPOSE

Although depression is a risk factor for stroke in large prospective studies, it is unknown whether these conditions have a shared genetic basis.

METHODS

We applied a polygenic risk score (PRS) for major depressive disorder derived from European ancestry analyses by the Psychiatric Genomics Consortium to a genome-wide association study of ischemic stroke in the Stroke Genetics Network of National Institute of Neurological Disorders and Stroke. Included in separate analyses were 12 577 stroke cases and 25 643 controls of European ancestry and 1353 cases and 2383 controls of African ancestry. We examined the association between depression PRS and ischemic stroke overall and with pathogenic subtypes using logistic regression analyses.

RESULTS

The depression PRS was associated with higher risk of ischemic stroke overall in both European (P=0.025) and African ancestry (P=0.011) samples from the Stroke Genetics Network. Ischemic stroke risk increased by 3.0% (odds ratio, 1.03; 95% confidence interval, 1.00-1.05) for every 1 SD increase in PRS for those of European ancestry and by 8% (odds ratio, 1.08; 95% confidence interval, 1.04-1.13) for those of African ancestry. Among stroke subtypes, elevated risk of small artery occlusion was observed in both European and African ancestry samples. Depression PRS was also associated with higher risk of cardioembolic stroke in European ancestry and large artery atherosclerosis in African ancestry persons.

CONCLUSIONS

Higher polygenic risk for major depressive disorder is associated with increased risk of ischemic stroke overall and with small artery occlusion. Additional associations with ischemic stroke subtypes differed by ancestry.

Dietary patterns, body mass index and inflammation: Pathways to depression and mental health problems in adolescents

BACKGROUND

Observational studies suggest that dietary patterns may impact mental health outcomes, although biologically plausible pathways are yet to be tested. We aimed to elucidate the longitudinal relationship between dietary patterns, adiposity, inflammation and mental health including depressive symptoms in a population-based cohort of adolescents.

METHODS

Data were provided from 843 adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study at 14 and 17 years (y) of age. Structural equation modelling was applied to test our hypothesised models relating dietary patterns, energy intake and adiposity (body mass index) at 14 y to adiposity and the pro-inflammatory adipokine (leptin) and inflammation (high sensitivity C-reactive protein - hs-CRP) at 17 y, and these inflammatory markers to depressive symptoms (Beck Depression Inventory) and Internalising and Externalising Behavioral Problems (Child Behavior Check List Youth Self- Report) at 17 y. We further tested a reverse hypothesis model, with depression at 14 y as a predictor of dietary patterns at the same time-point.

RESULTS

The tested models provided a good fit to the data. A 'Western' dietary pattern (high intake of red meat, takeaway, refined foods, and confectionary) at 14 y was associated with higher energy intake and BMI at 14 y, and with BMI and biomarkers of inflammation at 17 y (all p < .05). A 'Healthy' dietary pattern (high in fruit, vegetables, fish, whole-grains) was inversely associated with BMI and inflammation at 17 y (p < .05). Higher BMI at 14 y was associated with higher BMI (p < .01), leptin (p < .05), hs-CRP (p < .05), depressive symptoms (p < .05) and mental health problems (p < .05), all at 17 y.

CONCLUSION

A 'Western' dietary pattern associates with an increased risk of mental health problems including depressive symptoms in adolescents, through biologically plausible pathways of adiposity and inflammation, whereas a 'Healthy' dietary pattern appears protective in these pathways. Longitudinal modelling into adulthood is indicated to confirm the complex associations of dietary patterns, adiposity, inflammation and mental health problems, including depressive symptoms.

Rationale and design of the Hunting for the off-target propertIes of Ticagrelor on Endothelial function and other Circulating biomarkers in Humans (HI-TECH) trial

BACKGROUND

Among the 3 approved oral P2Y₁₂ inhibitors for the treatment for patients with acute coronary syndrome (ACS), ticagrelor, but not prasugrel or clopidogrel, has been associated with off-target properties, such as improved endothelial-dependent vasomotion and increased adenosine plasma levels.

METHODS

The HI-TECH study (NCT02587260) is a multinational, randomized, open-label, crossover study with a Latin squares design, conducted at 5 European sites, in which patients free from recurrent ischemic or bleeding events ≥30 days after a qualifying ACS were allocated to sequentially receive a 30 ± 5-day treatment with prasugrel, clopidogrel, and ticagrelor in random order. The primary objective was to evaluate whether ticagrelor, at treatment steady state (ie, after 30 ± 5 days of drug administration), as compared with both clopidogrel and prasugrel, is associated with an improved endothelial function, assessed with peripheral arterial tonometry. Thirty-six patients undergoing evaluable endothelial function assessment for each of the assigned P2Y₁₂ inhibitor were needed to provide 90% power to detect a 10% relative change of the reactive hyperemia index in the ticagrelor group.

CONCLUSION

The HI-TECH study is the first randomized, crossover study aiming to ascertain whether ticagrelor, when administered at approved regimen in post-ACS patients, improves endothelial function as compared with both clopidogrel and prasugrel.

Validation of Repeated Endothelial Function Measurements Using EndoPAT in Stroke

Background

Decreased endothelial function (EF) may be a prognostic marker for stroke. Measuring pharmacological effects on EF may be of interest in the development of personalized medicine for stroke prevention. In this study, we assessed the reliability of repeated EF measurements using a pulse amplitude tonometry technology in acute stroke patients. Similarly, reliability was tested in healthy subjects devoid of vascular disease to estimate reactivity and reliability in a younger non-stroke population.

Materials and methods

EF was assessed using the EndoPAT2000 in 20 healthy volunteers (men 50%, mean age 35.85 ± 3.47 years) and 21 stroke patients (men 52%, mean age 66.38 ± 2.85 years, and mean NIHSS 4.09 ± 0.53) under standardized conditions. EF was measured as the reactive hyperemia index (RHI), logarithm of RHI (lnRHI), and Framingham RHI (fRHI). Measurements were separated by 1.5 and 24 h to assess same-day and day-to-day reliability, respectively.

Results

Fair to moderate correlations of measurements [intraclass correlation coefficient (ICC)_same-day 0.29 and ICC_day-to-day 0.52] were detected in healthy subjects. In stroke patients, we found moderate to substantial correlation of both same-day and day-to-day repeated measurements (ICC_same-day 0.40 and ICC_day-to-day 0.62). fRHI compared with RHI and lnRHI showed best reliability.

Conclusion

Repeated measurements of fRHI in stroke patients show moderate reliability on same-day and substantial on day-to-day measurements. Likewise, in healthy subjects there was substantial reliability on day-to-day measurement, but only moderate on same-day measurements. In general, day-to-day correlation of repeated EF measurements was far better than that of same-day measurements, which ranged from poor to moderate depending on the specific outcome measure of EF. A possible carryover effect should be considered if same-day repeated testing of drug effects is applied in future studies.

Impact of psychological health on peripheral endothelial function and the HPA-axis activity in healthy adolescents

BACKGROUND AND AIMS

The development of adolescence psychological health over a 3-year period and its relationship to peripheral endothelial function and the hypothalamic-pituitary-adrenal (HPA)-axis activity were examined in a cohort of healthy adolescents in a longitudinal study.

METHODS

A total of 162 adolescents (94 females) participated in both baseline (mean age 14.5 ± 1 years) and three-year follow-up studies. Psychological health was evaluated by self-report using the Beck Youth Inventories of Emotional and Social Impairment and the psychosomatic problem scale. Peripheral endothelial function was assessed using a peripheral artery tonometry device. The HPA-axis activity measured as cortisol awakening response (CAR) was assessed only at follow-up by collecting two saliva samples, immediately after awakening and 15 min later. Physical activity, smoking and parental education were assessed by questionnaires.

RESULTS

Adolescents reported increased depression and decreased anger over three years, while only females reported increased psychosomatic complaints. Reduced peripheral endothelial function was associated with high level of anger (β = -0.332, p = 0.018) and disruptive behaviour (β = -0.390, p = 0.006) over three years in males, but not in females, after adjusting for covariates. Blunted cortisol awakening response was associated with high level of anxiety (β = -0.235, p = 0.017), depression (β = -0.203, p = 0.038), anger (β = -0.185, p = 0.048), and low level of self-concept (β = 0.289, p = 0.002) after adjusting for covariates.

CONCLUSIONS

High level of negative emotions during adolescence may have adverse effects on peripheral endothelial function and the regulation of the HPA-axis activity, while high level of self-concept might be protective.

Associations of low grade inflammation and endothelial dysfunction with depression - The Maastricht Study

BACKGROUND

The pathogenesis of depression may involve low-grade inflammation and endothelial dysfunction. We aimed to evaluate the independent associations of inflammation and endothelial dysfunction with depressive symptoms and depressive disorder, and the role of lifestyle factors in this association.

METHODS

In The Maastricht Study, a population-based cohort study (n=852, 55% men, m=59.8±8.5years), depressive symptoms were assessed with the Patient Health Questionnaire-9 and (major and minor) depressive disorder with the Mini-International Neuropsychiatric Interview. Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-α) and endothelial dysfunction (sVCAM-1, sICAM-1, sE-selectin, vWF) were measured with sandwich immunoassays and combined into two standardized sum scores.

RESULTS

Biomarkers of inflammation (hsCRP, TNF-α, SAA, sICAM-1) and endothelial dysfunction (sICAM-1, sE-Selectin) were univariately associated with depressive symptoms and depressive disorder. The sum scores of inflammation and endothelial dysfunction were associated with depressive disorder after adjustment for age, sex, type 2 diabetes, kidney function and prior cardiovascular disease (OR 1.54, p=0.001 and 1.40, p=0.006). Both sum scores remained significantly associated with depressive disorder after additional adjustment for lifestyle factors smoking, alcohol consumption and body mass index. The sum score of inflammation was also independently associated with depressive symptoms, while the sum score of endothelial dysfunction was not.

CONCLUSIONS

Inflammation and endothelial dysfunction are both associated with depressive disorder, independent of lifestyle factors. Our results might suggest that inflammation and endothelial dysfunction are involved in depression.

Endothelial dysfunction and negative emotions in adolescent girls

BACKGROUND

Endothelial dysfunction predicts adult cardiovascular disorder and may be associated with negative emotions in adolescents. This study was conducted to determine if hopelessness, hostility, and depressive, anxiety, or conduct disorders were associated with compromised endothelial function and whether those associations were mediated by health risk behaviors.

METHODS

Endothelial function, assessed through brachial artery reactive hyperemia, was measured in a psychopathology enriched sample of 60 15-18-year-old girls. The correlations between hopelessness, hostility, and depressive, anxiety, or conduct disorders and the percent change in forearm vascular resistance (PCFVR) were measured. Possible mediation effects of health risk behaviors were tested.

RESULTS

Hopelessness was negatively associated with PCFVR, controlling for race and body mass index. Conduct disorder without any anxiety disorder was associated with better endothelial function. The other negative emotions were not associated with PCFVR. Risky health behaviors were associated with conduct disorder and hopelessness, but not with PCFVR, so there was no evidence of mediation.

CONCLUSION

The main finding was that hopelessness in adolescent girls was associated with endothelial dysfunction. This may indicate that when present, hopelessness places a girl at risk for later cardiovascular disease, whether she has a psychiatric disorder or not. Possible mechanisms for this finding are examined and the surprising finding that conduct disorder is associated with better endothelial function is also discussed. Suggestions for future research are presented.

Enhanced External Counterpulsation Is an Effective Treatment for Depression in Patients With Refractory Angina Pectoris

OBJECTIVE

To examine the effect of enhanced external counterpulsation (EECP) on depression in patients with refractory angina pectoris (Canadian Cardiovascular Society class 2-4).

METHOD

The study was a prospective observational investigation with a 2-month control period preceding the EECP therapy (to minimize a possible effect of the regression-toward-the-mean phenomenon). The patients were examined 2 months before and just before EECP and just after, 3 months after, and 12 months after EECP. Depression was assessed using the Major Depression Inventory and the ICD-10. During EECP, 3 sets of cuffs were fastened around the lower extremities and were inflated sequentially to a pressure of 260 mm Hg in each diastole for 60 minutes 5 days a week for 7 weeks (35 sessions). The study was conducted at a regional hospital in Denmark from May 2006 to January 2011.

RESULTS

Fifty patients with angina pectoris and an abnormal coronary angiography, with no possibility for revascularization, were included (72% men, mean age of 63 years) between May 2006 and January 2011. The prevalence of depression before EECP was 18%, just after was 2%, 3 months after was 2%, and 12 months after was 4% (P = .013). The depressive state was more severe at a lower age (P = .016). No significant predictors of effect of EECP on depression were found (P > .05), and no association was detected between decline in depressive state and chest pain (P > .05).

CONCLUSIONS

The study indicates that EECP is an effective treatment for depression in patients with refractory angina pectoris, that depression is more severe in younger patients, and that the effect of EECP on depression is not related to the effect on chest pain.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01112163.

The SENSE Study (Sleep and Education: learning New Skills Early): a community cognitive-behavioural therapy and mindfulness-based sleep intervention to prevent depression and improve cardiac health in adolescence

Background

Sleep problems are a major risk factor for the emergence of depression in adolescence. The aim of this study was to test whether an intervention for improving sleep habits could prevent the emergence of depression, and improve well-being and cardiovascular indices amongst at-risk adolescents.

Methods/Design

A longitudinal randomised controlled trial (RCT) is being conducted across Victorian Secondary Schools in Melbourne, Australia. Adolescents (aged 12–17 years) were defined as at-risk for depression if they reported high levels of anxiety and sleep problems on in-school screening questionnaires and had no prior history of depression (assessed by clinical diagnostic interview). Eligible participants were randomised into either a sleep improvement intervention (based on cognitive behavioral and mindfulness principles) or an active control condition teaching study skills. Both programs consisted of seven 90 minute-long sessions over seven weeks. All participants were required to complete a battery of mood and sleep questionnaires, seven-days of actigraphy, and sleep diary entry at pre- and post-intervention. Participants also completed a cardiovascular assessment and two days of saliva collection at pre-intervention. Participants will repeat all assessments at two-year follow up (ongoing).

Discussion

This will be the first efficacy trial of a selective group-based sleep intervention for the prevention of depression in an adolescent community sample. If effective, the program could be disseminated in schools and greatly improve health outcomes for anxious adolescents.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12612001177842. Date of Registration: 06-Nov-2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-015-0096-x) contains supplementary material, which is available to authorized users.

The development of depressive symptoms during medical internship stress predicts worsening vascular function

OBJECTIVE

We sought to prospectively determine whether the onset of internship stress and any subsequent depression alters physiological markers of early vascular disease

METHODS

We explored potential mechanisms linking stress and depression to vascular disease in a prospective cohort of 37 participants exposed to medical internship stress, an established precipitant of depressive symptomatology.

RESULTS

Change in depressive symptom score from baseline over one year of internship stress was inversely correlated with change in the reactive hyperemia index (RHI), a measure of peripheral endothelial function (r=0.41, p=0.01). The change in depressive symptoms in the first six months of internship was similarly related to change in RHI over one year (r=0.38, p=0.02). While the development of depressive symptoms did not significantly impact changes in endothelial progenitor cells (EPCs), EPCs did significantly decrease with the year of internship stress (11.9 to 3.4cells/ml blood; p=0.01).

CONCLUSION

Endothelial function may be a critical link between stress, depression, and cardiovascular disease and a feasible surrogate outcome for prospective studies.

Relationships between Depressive Symptoms and Endothelial Function Among Outpatients of a General Hospital in China

Background

This study aimed to investigate the endothelial function by reactive hyperemia index (RHI) in patients with depression, subjects recovering from depression, and subjects without a history of depression.

Material/Methods

Outpatients were recruited from a general hospital in China; 62 patients diagnosed with depression and the 17-item Hamilton Rating Scale for Depression (HAMD17) total scores ≥17 were enrolled as the depression group, 62 patients with a history of depression, discontinuation of antidepressants therapy at least 3 months ago, and HAMD17 ≤7 were recruited as remission group, and 62 subjects without a history of depression served as the control group (HAMD17 ≤7).

Results

The mean RHI was 1.93, 2.34, and 2.19 in depression, control, and remission groups, respectively, showing a significant difference among the 3 groups (P=0.0004). In addition, a marked difference in RHI was found between depression and control groups (P=0.0003) and between depression and remission groups (P=0.0270). However, there was no significant difference between remission and control groups (P=0.3363).

Conclusions

There is a relationship between depression and endothelial dysfunction in outpatients from a general hospital in China. The improvement of depression is synchronous with the improvement of endothelial function.

Early physiological markers of cardiovascular risk in community based adolescents with a depressive disorder

BACKGROUND

Depression is recognised as an independent cardiovascular risk factor in adults. Identifying this relationship early on in life is potentially important for the prevention of cardiovascular disease (CVD). This study investigated whether clinical depression is associated with multiple physiological markers of CVD risk in adolescents from the general community.

METHODS

Participants aged 12-18 years were recruited from the general community and screened for depressive symptoms. Individuals with high and low depressive symptoms were administered a diagnostic interview. Fifty participants, 25 with a current depressive episode and 25 matched healthy controls, subsequently completed cardiovascular assessments. Variables assessed were automatic brachial and continuous beat-to-beat finger arterial blood pressure, heart rate, vascular functioning by pulse amplitude tonometry following reactive hyperaemia and pulse transit time (PTT) at rest. Blood samples were collected to measure cholesterol, glucose and glycohaemoglobin levels and an index of cumulative risk of traditional cardiovascular risk factors was calculated.

RESULTS

Depressed adolescents had a significantly lower reactive hyperaemia index and shorter PTT, suggesting deterioration in vascular integrity and structure. Higher fasting glucose and triglyceride levels were also observed in the depressed group, who also had higher cumulative risk scores indicative of increased engagement in unhealthy behaviours and higher probability of advanced atherosclerotic lesions.

LIMITATIONS

The sample size and number of males who completed all cardiovascular measures was small.

CONCLUSIONS

Clinically depressed adolescents had poorer vascular functioning and increased CVD risk compared to controls, highlighting the need for early identification and intervention for the prevention of CVD in depressed youth.

Endothelial health in childhood acute lymphoid leukemia survivors: pilot evaluation with peripheral artery tonometry

BACKGROUND

Childhood cancer survivors are a growing population at risk for poor cardiac outcomes. Acute lymphoid leukemia (ALL) survivors are among those at increased risk of cardiovascular complications. Early identification of impaired vascular health may allow for interventions to improve these outcomes. The purpose of this study was to evaluate vascular health using peripheral artery tonometry in ALL survivors and compare results with healthy siblings.

PROCEDURE

Sixteen ALL survivor, healthy sibling pairs, aged 8 to 20 years, were evaluated for vascular health and cardiovascular risk factors (body mass index, central adiposity, blood pressure, and fitness). One-tailed paired t test was used to compare the groups.

RESULTS

Survivors were similar to siblings in cardiovascular risk measures but had poorer vascular health as measured by reactive hyperemia index (survivor RHI 1.54 vs. sibling 1.77; P=0.0474).

CONCLUSION

This study reveals that even among survivors who are comparable to their healthy siblings in other traditional cardiovascular risks, there is evidence of poorer vascular health.

Depression and cardiovascular disease: an update on how course of illness may influence risk

Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary.

Reproducibility of peripheral arterial tonometry for the assessment of endothelial function in adults

OBJECTIVES

Endothelial dysfunction is associated to cardiovascular risk factors and predicts cardiovascular events. Peripheral arterial tonometry (PAT) is a novel noninvasive method to assess endothelial function. However, there is a paucity of data about its reproducibility. The aim of this study was to assess the feasibility and reproducibility of PAT in adults.

METHODS

PAT exams were performed twice in the same day in 123 participants of a cohort about the determinants of diabetes and cardiovascular diseases (Brazilian Longitudinal Study of Adult Health--ELSA-Brasil). The interval between the exams was 2-6 h (mean=4 h). Endothelial function in PAT method is measured by reactive hyperemia index (RHI), which evaluates arterial pulsatile volume changes in response to hyperemia. Agreement of RHI values was compared by Bland-Altman method, coefficient of variation and coefficient of repeatability. Reliability was assessed by intraclass correlation coefficient (ICC).

RESULTS

Mean values of RHI did not differ significantly between the exams of each participant (1.92±0.56 vs. 1.96±0.58, P=0.48). There were no systematic errors between the exams (mean of differences=-0.03±0.5). Measurement error was 0.35, coefficient of variation was 18.0% and ICC was 0.61. Sex, age or the presence of obesity did not have a considerable influence on the reproducibility of PAT.

CONCLUSION

PAT exam is feasible and has acceptable reproducibility in adults when compared with other noninvasive methods for endothelial function assessment. This performance makes PAT a promising method for future clinical and epidemiological studies.

Test-retest reliability of peripheral arterial tonometry in the metabolic syndrome

Endothelial dysfunction is an important contributor to atherosclerosis and cardiovascular disease. However, routine assessment via angiography or flow-mediated dilation is difficult due to technical limitations. Peripheral arterial tonometry (PAT) is a promising alternative method for non-invasive assessment of endothelial dysfunction. This study assessed the test-retest reliability of PAT in adults with the metabolic syndrome (n = 20) and provides sample size and power estimates for study design. Participants completed five PAT tests each separated by 1 week. The PAT-derived reactive hyperaemia index (RHI) showed robust repeatability (intra-class correlation = 0.74). A parallel-arm study powered at 0.90 would require 22 participants to detect an absolute change in RHI of 0.40 units (equal to ~25% change in this sample), whereas a crossover study would require 12 participants. In conclusion, we have demonstrated that PAT can be used to assess endothelial dysfunction in adults with the metabolic syndrome as reliably as in healthy samples.

Associations between depression and anxiety symptoms and retinal vessel caliber in adolescents and young adults

OBJECTIVE

Previous longitudinal studies suggest that depression and anxiety are associated with risk for cardiovascular disease. The aim of the present study was to test whether an association between depression and anxiety symptoms and retinal vessel caliber, an indicator of subclinical cardiovascular risk, is apparent as early as adolescence and young adulthood.

METHODS

Participants were 865 adolescents and young adults who participated in the Brisbane Longitudinal Twin Study and the Twin Eye Study in Tasmania. Participants completed an assessment of depression/anxiety symptoms (the Somatic and Psychological Health Report) when they were 16.5 years old (mean age), and they underwent retinal imaging, on average, 2.5 years later (range, 2 years before to 7 years after the depression/anxiety assessment). Retinal vessel caliber was assessed using computer software.

RESULTS

Depression and anxiety symptoms were associated with wider retinal arteriolar caliber in this sample of adolescents and young adults (β = 0.09, p = .016), even after adjusting for other cardiovascular risk factors (β = 0.08, p = .025). Multiple regression analyses revealed that affective symptoms of depression/anxiety were associated with retinal vessel caliber independently of somatic symptoms.

CONCLUSIONS

Depression and anxiety symptoms are associated with measurable signs in the retinal microvasculature in early life, suggesting that pathological microvascular mechanisms linking depression/anxiety and cardiovascular disease may be operative from a young age.

Peripheral microvascular dysfunction predicts residual risk in coronary artery disease patients on statin therapy

OBJECTIVE

Although lowering of low-density lipoprotein cholesterol (LDL-C) by statins is essential in treatment of coronary artery disease (CAD) patients, there is considerable residual risk of secondary coronary artery events (CAE). We examined whether microvascular dysfunction (MiD), measured by peripheral artery tonometry (PAT), can predict prognosis of CAD patients previously treated with statins.

METHODS

We measured log-transformed reactive hyperemia index (L_RHI) in 213 CAD patients who had already achieved LDL-C <100 by statin therapy. Patients were followed-up for secondary CAE for a median of 2.7 years. Patients were divided into two groups: L_RHI ≥ 0.54 (n = 99) and L_RHI < 0.54 (n = 114).

RESULTS

During follow-up, CAE occurred in 4 (4.0%) patients in the L_RHI ≥ 0.54 group and 18 (15.8%) patients in the L_RHI < 0.54 group (P = 0.006). Cox regression analysis indicated that L_RHI was an independent predictor for CAE even after adjustment by Framingham traditional risk factors (FRF; age, T-C/HDL-C ratio, systolic blood pressure, diabetes, current smoker, and gender) and estimated glomerular filtration rate (eGFR) for secondary CAE (HR 0.79, 95% CI: 0.66-0.95). ROC analysis for CAE prediction showed that the AUC for models including FRF only, FRF + eGFR, and FRF + eGFR + L_RHI were 0.60, 0.71, and 0.77, respectively. Moreover, adding eGFR to FRF only (0.63, P = 0.003) and adding L_RHI to the FRF + eGFR model were associated with significant improvement of net reclassification improvement (0.79, P = 0.007).

CONCLUSION

MiD measured by non-invasive PAT adds incremental predictive ability to traditional risk factors for prognosis of CAD patients successfully treated with statins.

Differential associations of depressive symptom dimensions with cardio-vascular disease in the community: results from the Gutenberg health study

A current model suggested that the somatic symptom dimension accounts for the adverse effect of depression in patients with coronary heart disease (CHD). In order to test this model we sought to determine in a large population-based sample how symptom dimensions of depression are associated with CHD, biomarkers and traditional risk factors. The associations of cognitive and somatic symptom dimensions of depression with CHD, risk factors, endothelial function, and biomarkers of inflammation and myocardial stress were analyzed cross-sectionally in a sample of n = 5000 Mid-Europeans aged 35–74 years from the Gutenberg Health Study (GHS). Only the somatic symptom dimension of depression was associated with CHD, biomarkers (inflammation, vascular function) and cardio-vascular risk factors. When multivariable adjustment was applied by demographic and cardiovascular risk factors, the weak associations of the somatic symptom dimension with the biomarkers disappeared. However, the associations of the somatic symptom dimension with CHD, myocardial infarction, obesity, dyslipidemia and family history of myocardial infarction remained. Both dimensions of depression were independently associated with a previous diagnosis of depression and distressed personality (type D). Thus, our results partly confirm current models: Somatic, but not cognitive-affective symptom dimensions are responsible for the association between depression and CHD, inflammation, vascular function and cardiovascular risk factors in the general population. However, our findings challenge the assumptions that somatic depression might be due to inflammation or vascular dysfunction as consequence of progressed atherosclerotic disease. They rather emphasize a close interplay with life-style factors and with a family history of MI.

Heart rate time irreversibility is impaired in adolescent major depression

We aimed to study heart rate time irreversibility--a nonlinear qualitative characteristics of heart rate variability indicating complexity of cardiac autonomic control at rest and in response to physiological stress (orthostasis) in never-treated major depressive disorder (MDD) adolescent female patients.

METHODS

We studied 20 MDD girls and 20 healthy age-matched girls at the age of 15 to 18 years. The ECG was recorded in supine position and in response to position change from lying to standing (orthostasis). Time irreversibility analysis was performed using Porta's (P%), Guzik's (G%) and Ehlers' (E) index. The depressive disorder severity was evaluated using Montgomery-Asberg Depression Rating Scale (MADRS) and Children's Depression Inventory (CDI).

RESULTS

Resting heart rate time irreversibility indices (logG%, logP%, Ehlers' index) were significantly reduced in MDD female patients without significant differences in response to orthostasis in MDD girls compared to controls. No significant correlations between time irreversibility and MDD severity were observed.

CONCLUSION

This study revealed the impaired heart rate asymmetry pattern indicating an altered complexity of cardiac autonomic regulation in adolescent female patients suffering from MDD.

Heartache and heartbreak--the link between depression and cardiovascular disease

The close, bidirectional relationship between depression and cardiovascular disease is well established. Major depression is associated with an increased risk of coronary artery disease and acute cardiovascular sequelae, such as myocardial infarction, congestive heart failure, and isolated systolic hypertension. Morbidity and mortality in patients with cardiovascular disease and depression are significantly higher than in patients with cardiovascular disease who are not depressed. Various pathophysiological mechanisms might underlie the risk of cardiovascular disease in patients with depression: increased inflammation; increased susceptibility to blood clotting (owing to alterations in multiple steps of the clotting cascade, including platelet activation and aggregation); oxidative stress; subclinical hypothyroidism; hyperactivity of the sympatho-adrenomedullary system and the hypothalamic-pituitary-adrenal axis; reductions in numbers of circulating endothelial progenitor cells and associated arterial repair processes; decreased heart rate variability; and the presence of genetic factors. Early identification of patients with depression who are at risk of cardiovascular disease, as well as prevention and appropriate treatment of cardiovascular disease in these patients, is an important and attainable goal. However, adequately powered studies are required to determine the optimal treatment regimen for patients with both depression and cardiovascular disorders.

Test-retest reliability of pulse amplitude tonometry measures of vascular endothelial function: implications for clinical trial design

Endothelial dysfunction is an important outcome for assessing vascular health in intervention studies. However, reliability of the standard non-invasive method (flow-mediated dilation) is a significant challenge for clinical applications and multicenter trials. We evaluated the repeatability of pulse amplitude tonometry (PAT) to measure change in pulse wave amplitude during reactive hyperemia (Itamar Medical Ltd, Caesarea, Israel). Twenty healthy adults completed two PAT tests (mean interval = 19.5 days) under standardized conditions. PAT-derived measures of endothelial function (reactive hyperemia index, RHI) and arterial stiffness (augmentation index, AI) showed strong repeatability (intra-class correlations = 0.74 and 0.83, respectively). To guide future research, we also analyzed sample size requirements for a range of effect sizes. A crossover design powered at 0.90 requires 28 participants to detect a 15% change in RHI. Our study is the first to show that PAT measurements are repeatable in adults over an interval greater than 1 week.

Vascular function is not impaired early in the course of bipolar disorder

OBJECTIVE

Individuals with bipolar disorder face a nearly two-fold increased risk of cardiovascular mortality relative to the general population. Endothelial dysfunction precedes cardiovascular disease and serves as a quantifiable phenotype for vasculopathy. We investigated whether individuals with bipolar disorder had poorer vascular function than controls using a case-control design.

METHODS

The sample of 54 participants included 27 individuals with bipolar disorder and 27 age- and gender-matched controls. Participants underwent an assessment of metabolic (weight, lipids, and insulin resistance) and vascular parameters (endothelial function using flow-mediated dilation; arterial stiffness using pulse wave velocity and estimated aortic pressure).

RESULTS

Participants had a mean age of 32 years and 41% were female. No significant differences were found between groups in endothelial function or arterial stiffness. Individuals with bipolar disorder demonstrated 100% greater insulin resistance.

CONCLUSION

The lack of clinically significant differences in vascular function in this young sample suggests any increased risk either occurs later in the course of illness or is largely due to behavioral risk factors, such as smoking, which was balanced between groups. Substantial insulin resistance is identifiable early in course of illness, perhaps secondary to treatment.

Job strain and shift work influences on biomarkers and subclinical heart disease indicators: a pilot study

This pilot study is one of the first to examine the impact of job strain and shift work on both the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis using two salivary stress biomarkers and two subclinical heart disease indicators. This study also tested the feasibility of a rigorous biological sampling protocol in a busy workplace setting. Paramedics (n = 21) self-collected five salivary samples over 1 rest and 2 workdays. Samples were analyzed for α-amylase and cortisol diurnal slopes and daily production. Heart rate variability (HRV) was logged over 2 workdays with the Polar RS800 Heart Rate monitors. Endothelial functioning was measured using fingertip peripheral arterial tonometry. Job strain was ascertained using a paramedic-specific survey. The effects of job strain and shift work were examined by comparing paramedic types (dispatchers vs. ambulance attendants) and shift types (daytime vs. rotating day/night). Over 90% of all expected samples were collected and fell within expected normal ranges. Workday samples were significantly different from rest day samples. Dispatchers reported higher job strain than ambulance paramedics and exhibited reduced daily alpha-amylase production, elevated daily cortisol production, and reduced endothelial function. In comparison with daytime-only workers, rotating shift workers reported higher job strain, exhibited flatter α-amylase and cortisol diurnal slopes, reduced daily α-amylase production, elevated daily cortisol production, and reduced HRV and endothelial functioning. Despite non-statistically significant differences between group comparisons, the consistency of the overall trend in subjective and objective measures suggests that exposure to work stressors may lead to dysregulation in neuroendocrine activity and, over the long-term, to early signs of heart disease. Results suggest that further study is warranted in this population. Power calculations based on effect sizes in the shift type comparison suggest a study size of n = 250 may result in significant differences at p = 0.05. High compliance among paramedics to complete the intensive protocol suggests this study will be feasible in a larger population.

Depressed mood and flow-mediated dilation: a systematic review and meta-analysis

OBJECTIVE

This systematic and quantitative review evaluates the literature on associations between depressed mood and flow-mediated dilation (FMD), a measure of endothelial function, in adults.

METHODS

Published English-language articles (through December 2010) were identified from literature searches, assessed for data extraction, and evaluated for quality.

RESULTS

The literature includes cross-sectional (n = 9) and retrospective examinations (n = 3) of how FMD correlates with clinical or subclinical depression in healthy adults and cardiovascular patients (total N across 12 studies = 1491). FMD was assessed using a variety of methodologies. Samples were predominately older white and Asian subjects with higher socioeconomic status. In eight of the 12 articles selected for this review, at least one significant inverse association was noted between depressed mood and FMD, with primarily moderate effect sizes. The overall meta-analysis (random-effects model) revealed a combined effect size of correlation coefficient r = 0.19 (95% confidence interval = 0.08-0.29, p = .001). Significant combined effects were found for subgroups of studies that a) received better quality ratings (r = 0.29), b) examined patients with cardiovascular disease or with cardiovascular disease risk factors/comorbidity (r = 0.29), c) used maximum vasodilation to quantify FMD (r = 0.27), and d) assessed samples that had a mean age of 55 years and older (r = 0.15).

CONCLUSIONS

Diverse studies support the inverse correlation between depressed mood and endothelial function, as measured by FMD. This literature would be strengthened by prospective studies, increased methodological consistency in FMD testing, and broader sampling (e.g., African Americans, younger age, lower socioeconomic status).

Depression, anxiety, and arterial stiffness

BACKGROUND

Arterial stiffness gains attention as a potential mechanism underlying the frequently found association between depression or anxiety and cardiovascular disease. However, observations regarding stiffness and psychopathology were often based on small samples. The current study aimed to examine whether subjects with a diagnosis of depressive or anxiety disorder showed increased stiffness and to explore associations between various psychiatric characteristics and arterial stiffness.

METHODS

The sample included 449 cases with DSM-IV based lifetime diagnoses of depressive and/or anxiety disorder and 169 control subjects. Subjects were participating in the Netherlands Study of Depression and Anxiety and were aged 20 to 66 years. Characteristics included comorbidity, subtype of disorder, symptom severity and duration, age of onset, and use of antidepressant medication. Arterial stiffness was measured by calibrated radial tonometry (heart rate normalized central augmentation index [AIx75]; in percentage) and carotid M-mode ultrasound (distensibility coefficient).

RESULTS

After adjustment for covariates, AIx75 was increased in current (1-month) depression or anxiety (15.7% vs. 13.3% in control subjects, p = .01). Disorder characteristics associated with AIx75 were depression and anxiety comorbidity (15.3%, p = .02), higher depression severity (β = .10, p < .001) and anxiety severity (β = .10, p < .001), and longer symptom duration (β = .07, p = .01). No significant associations were found between distensibility coefficient and psychopathology.

CONCLUSIONS

Current depressive or anxiety disorders were associated with a higher central augmentation index, a manifestation of early wave reflection because of arterial stiffness. Exposure to depression and anxiety may therefore enhance the development and progression of atherosclerosis and other cardiovascular conditions.

The association between major depressive disorder and obesity in US adolescents: results from the 2001-2004 National Health and Nutrition Examination Survey

The association between major depressive disorder (MDD) and obesity was assessed in 4,150 US adolescents aged 12-19 years from the 2001-2004 National Health and Nutrition Examination Survey. Weight and height were measured by health professionals and MDD was based on a structured diagnostic interview. The prevalence of MDD in the past year among US adolescents was 3.2% and 16.8% of US adolescents were obese. After adjustment for sex, age, race/ethnicity and poverty, MDD was not significantly associated with obesity among adolescents overall (adjusted odds ratio (adjOR) = 1.6, 95% confidence interval (CI) = 0.9-2.9), but an increased odds of obesity was observed among males (adjOR = 2.7, 95% CI = 1.1-7.1) and non-Hispanic blacks (adjOR = 3.1, 95% CI = 1.1-8.3) with MDD. Future research on strategies that might reduce the risk of obesity in males and non-Hispanic black adolescents with MDD may be warranted.

Depression and altered serum lipids in cynomolgus monkeys consuming a Western diet

Research over the past 15 years has suggested a high comorbidity of depression and coronary heart disease (CHD). However the mechanisms responsible for this relationship are poorly understood. This study was designed to examine the relationships between depressive behaviors and concentrations of circulating lipids and lipid signaling molecules that may be common to both CHD and depression in a cohort of cynomolgus monkeys (Macaca fascicularis) consuming a 'Western' diet, enriched with saturated fat and cholesterol. Socially-housed adult female cynomolgus monkeys (n=36) were fed the Western diet for 27 months and depressive behavior was recorded weekly. Body weight, body mass index and circulating cholesterol profiles were measured in all animals, and fatty acids (FA) and FA-based signaling molecules were measured in the 6 least and 6 most depressed monkeys. Monkeys consuming the Western diet exhibited a broad range of percent time spent in depressive behavior. The percent time spent depressed was positively correlated with total plasma and LDL cholesterol and negatively correlated with HDL cholesterol. Despite being leaner, depressed monkeys had higher concentrations of monounsaturated fats (C16:1 and C17:1), a higher ω6/ω3 polyunsaturated fatty acid (PUFA) ratio and higher concentrations of omega-6 (ω6) PUFAs, particularly C18:2ω6 and C20:3ω6. FA ratios suggest that stearoyl CoA desaturase 1 activity was increased in depressed monkeys. Depressed female cynomolgus monkeys had elevated concentrations of serum lipids and lipid signaling molecules that are typically associated with obesity, insulin resistance and cardiovascular disease, which may account in part for the comorbidity of depression and CHD.

Multiwave associations between depressive symptoms and endothelial function in adolescent and young adult females

OBJECTIVE

Depression has been linked to endothelial dysfunction, and some research suggests that past depressive episodes are associated with a lasting, negative impact on the endothelium. However, investigations in this area have been predominantly cross-sectional, raising questions about the direction of these associations. Using a multiwave design, we sought to extend previous research in this area by examining whether depressive symptoms have a lasting negative influence on endothelial function.

METHODS

A total of 135 adolescent and young adult females with no known or suspected major health problems were followed for 2½ years. Endothelial function was assessed at three time points throughout the study. The Beck Depression Inventory was administered, and information about health practices was collected every 6 months.

RESULTS

Self-reported depressive symptoms covaried with endothelial functioning on a within-person basis (β = -0.23, p < .05). As a participant's depression symptoms rose beyond her typical level, her endothelial function declined commensurately. This association persisted after controlling for health practices and adiposity. There was no evidence that depressive symptoms predicted endothelial function at later time points or interacted with time to predict the trajectories of endothelial function over the follow-up period.

CONCLUSIONS

Depressive symptoms were concurrently associated with endothelial function in this cohort of healthy adolescent girls and young women. On visits when participants endorsed depressive symptoms that were higher than their mean level of depression, they tended to have worse endothelial function. We did not observe a lasting negative effect of depression on endothelial function.

Assessment of vascular endothelial function with peripheral arterial tonometry: information at your fingertips?

Endothelial dysfunction is an important component in the pathogenesis of atherosclerosis. The ability to assess the endothelium in a meaningful manner has been the subject of intense investigation over decades. Since the function of endothelial cells is a gauge of vascular health, assessment of vascular function is emerging as a useful tool for predicting cardiovascular risk and as a surrogate outcome measure for cardiovascular reduction intervention studies. This review highlights techniques for assessing endothelial function, focusing on a novel method of determining peripheral vascular reactivity via arterial tonometry.

Impaired vascular function in obese adolescents with insulin resistance

OBJECTIVE

To evaluate endothelial function (EF) in a cohort of obese adolescents with impaired insulin sensitivity.

STUDY DESIGN

Cardiovascular risk factors and adipocytokines, along with digital hyperemia, were evaluated by peripheral arterial tonometry (PAT) in adolescents with obesity and insulin resistance (IR) in relation to healthy, nonobese controls.

RESULTS

The obese and control subjects were of similar age (13.4+/-1.7 years vs 14.0+/-1.4 years) and sex. The obese subjects had IR (mean homeostasis model of assessment [HOMA] score=5.4; 95% confidence interval=3.3-7.5) and significantly greater body mass index (BMI) (BMI z-score 2.4+/-0.2 kg/m(2) vs 0.0+/-0.8 kg/m(2)) and waist circumference (WC) measures (109.6+/-11.1cm vs 70.5+/-9.4 cm) with elevated low-density lipoprotein cholesterol (LDL-C), triglyceride, and high-sensitivity C-reactive protein levels. The mean PAT ratio was significantly lower in obese adolescents compared with controls (1.51+/-0.4 vs 2.06+/-0.4; P=.002), indicative of impaired EF. Linear regression demonstrated associations between PAT ratio and BMI, WC, age, and LDL-C but not between PAT and leptin, resistin, or adiponectin levels or IR.

CONCLUSIONS

Obese adolescents with IR exhibited significantly worse EF as assessed by PAT compared with healthy, nonobese controls, and EF showed a significant association with measures of adiposity and other cardiovascular risk factors.

Broken-Hearted Women: The Complex Relationship between Depression and Cardiovascular Disease

The importance of mind–body health relationships has been recognized for decades, but only recently has the wider medical and cardiovascular community become engaged in understanding and addressing the complex, bidirectional risk relationship between cardiovascular disease (CVD) and depression. Furthermore, it has become increasingly clear that there are incompletely understood sex differences in incidence and outcomes for both conditions that should guide treatment and future research efforts. This review will explore the role of depression in women as a risk factor for incident CVD, its impact on women already suffering from CVD, proposed psychobiologic mechanisms and links, and the implications of sex differences on diagnosis and treatment.

Longitudinal platelet reactivity to acute psychological stress among older men and women

Platelet reactivity to acute stress is associated with increased cardiovascular disease risk; however, little research exists to provide systematic methodological foundations needed to generate strong longitudinal research designs. Study objectives were: 1) to evaluate whether markers of platelet function increase in response to an acute psychological stress test among older adults, 2) to establish whether reactivity remains robust upon repeated administration (i.e. three occasions approximately 1 year apart), and 3) to evaluate whether two different acute speech stress tasks elicit similar platelet responses. The 149 subjects (mean age 71 years) gave a brief impromptu speech on one of two randomly assigned topics involving interpersonal conflict. Blood samples drawn at baseline and post-speech were assayed using flow cytometry for platelet responses on three outcomes (% aggregates, % P-selectin expression, and % fibrinogen receptor expression). Three-level hierarchical linear modeling analyses revealed significant stress-induced increases in platelet activation on all outcomes (p < 0.001). No significant habituation on any measure was found. Additional reactivity differences were associated with male gender, history of myocardial infarction, and use of aspirin, statins, and antidepressants. The results demonstrate that laboratory acute stress tests continued to produce robust platelet reactivity on three activation markers among older adults over 3 years.

Assessment of endothelial function using digital pulse amplitude tonometry

The importance of endothelial dysfunction in the development and clinical expression of cardiovascular disease is well recognized. Impaired endothelial function has been associated with an increased risk of cardiovascular events. Endothelial function may be evaluated in humans by assessing vasodilation in response to stimuli known to induce the release of nitric oxide. A novel pulse amplitude tonometry device noninvasively measures vasodilator function in the microcirculation of the finger. This article reviews the recent studies that support the utility of digital pulse amplitude tonometry as a relevant test of peripheral endothelial function.

Persistent versus transient depressive symptoms in relation to platelet hyperactivation: a longitudinal analysis of dementia caregivers

BACKGROUND

Depressive symptoms and caregiving stress may contribute to cardiovascular disease (CVD) via chronic platelet activation; however, it remains unclear whether this elevated activation constitutes a trait or state marker. The primary objective was to investigate whether persistent depressive symptoms would relate to elevated platelet activation in response to acute psychological stress over a three-year period.

METHODS

Depressive symptoms (Brief Symptom Inventory) were assessed among 99 spousal dementia caregivers (52-88 years). Platelet P-selectin expression was assessed in vivo using flow cytometry at three time-points over the course of an acute stress test: baseline, post-stress, and after 14 min of recovery. Two competing structural analytic models of depressive symptoms and platelet hyperactivity with three yearly assessments were compared.

RESULTS

Although depressive symptoms were generally in the subclinical range, their persistent elevation was associated with heightened platelet reactivity and recovery at all three-years while the change in depressive symptoms from the previous year did not predict platelet activity.

LIMITATIONS

These results focus on caregivers providing consistent home care, while future studies may extend these results by modeling major caregiving stressors.

CONCLUSIONS

Enduring aspects of negative affect, even among those not suffering from clinical depression are related to hemostatic changes, in this case platelet reactivity, which might be one mechanism for previously reported increase in CVD risk among elderly Alzheimer caregivers.

Stress, depression, and coronary artery disease: modeling comorbidity in female primates

Depression and coronary heart disease (CHD) are leading contributors to disease burden in women. CHD and depression are comorbid; whether they have common etiology or depression causes CHD is unclear. The underlying pathology of CHD, coronary artery atherosclerosis (CAA), is present decades before CHD, and the temporal relationship between depression and CAA is unclear. The evidence of involvement of depression in early CAA in cynomolgus monkeys, an established model of CAA and depression, is summarized. Like people, monkeys may respond to the stress of low social status with depressive behavior accompanied by perturbations in hypothalamic-pituitary-adrenal (HPA), autonomic nervous system, lipid metabolism, ovarian, and neural serotonergic system function, all of which are associated with exacerbated CAA. The primate data are consistent with the hypothesis that depression may cause CAA, and also with the hypothesis that CAA and depression may be the result of social stress. More study is needed to discriminate between these two possibilities. The primate data paint a compelling picture of depression as a whole-body disease.