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Lee MK, Kim SW, Kim H, Park MJ, Fava M, Mischoulon D, Jeon HJ. Association between cerebral artery stenosis and depressive symptoms in elderly patients. J Affect Disord 2024; 361:53-58. [PMID: 38844169 DOI: 10.1016/j.jad.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To examine the association between cerebral artery stenosis and depressive symptoms in elderly patients. METHODS The study participants were 365 patients aged ≥65 years who visited the psychiatric outpatient clinic, Samsung Medical Center between January 1, 2000, and December 31, 2019, and were diagnosed with depressive disorder. They had brain imaging tests including magnetic resonance angiography (MRA), psychological evaluations including the 15-item Geriatric Depression Scale (GDS-15), and lab tests. Individuals' cerebral artery stenosis was identified and the association with significant depressive symptoms was examined. RESULTS Of the 365 subjects, 108 had at least one location of cerebral artery stenosis (29.6 %). The mean score of GDS-15 in the stenosis group was 8.1 (SD, 3.8), higher than the mean GDS-15 score of 6.5 (SD, 4.0) for the group without stenosis (p < 0.001). Compared to no middle cerebral artery (MCA) stenosis, having MCA stenosis was associated with significant depressive symptoms (p = 0.005). Compared to no posterior cerebral artery (PCA) stenosis, having left PCA stenosis was associated with significant depressive symptoms (p = 0.022). In the multivariable linear regression analysis, only bilateral MCA stenosis had a positive association with the score of GDS-15 (p = 0.013). CONCLUSION Bilateral MCA stenosis and left PCA stenosis are associated with significant depressive symptoms among elderly patients, with bilateral MCA stenosis positively associated with the severity of depression.
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Affiliation(s)
- Min Kang Lee
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Woo Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyewon Kim
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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2
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Mu J, Li J. Analysis of radiological features in patients with post-stroke depression and cognitive impairment. Rev Neurosci 2024; 35:565-573. [PMID: 38417835 DOI: 10.1515/revneuro-2023-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are common complications following a stroke, significantly impacting the quality of life and survival time of survivors. Currently, the comorbidity of PSCI and PSD is receiving increasing attention, as they share some common clinical characteristics, mechanisms, risk factors, radiological features, and treatment strategies. They influence each other, with the clinical prevalence of PSD comorbid with PSCI reaching as high as 26.15 %. The prevention, screening, diagnosis, and treatment of PSD and PSCI require collaboration across clinical, radiological, and neuropsychological evaluations. This paper aims to summarize the common radiological features of both conditions from a radiological perspective, which may aid in identifying early screening and predictive imaging biomarkers.
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Affiliation(s)
- Jun Mu
- Department of Neurology, 544251 The First Affiliated Hospital of Chongqing Medical University , Chongqing, 400016, China
| | - Jiayi Li
- Department of Neurology, 544251 The First Affiliated Hospital of Chongqing Medical University , Chongqing, 400016, China
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3
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Huang L, Liu X, Cheng Y, Qin R, Yang D, Mo Y, Ke Z, Hu Z, Mao C, Chen Y, Li J, Xu Y. Lower cerebrovascular reactivity in prefrontal cortex and weaker negative functional connectivity between prefrontal cortex and insula contribute to white matter hyperintensity-related anxiety or depression. J Affect Disord 2024; 354:526-535. [PMID: 38513774 DOI: 10.1016/j.jad.2024.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are associated with higher anxiety or depression (A/D) incidence. We investigated associations of WMHs with A/D, cerebrovascular reactivity (CVR), and functional connectivity (FC) to identify potential pathomechanisms. METHODS Participants with WMH (n = 239) and normal controls (NCs, n = 327) were assessed for A/D using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD). The CVR and FC maps were constructed from resting-state functional MRI. Two-way analysis of covariance with fixed factors A/D and WMH was performed to identify regional CVR abnormalities. Seed-based FC analyses were then conducted on regions with WMH × A/D interaction effects on CVR. Logistic regression models were constructed to examine the utility of these measurements for identifying WMH-related A/D. RESULTS Participants with WMH related A/D exhibited significantly greater CVR in left insula and lower CVR in right superior frontal gyrus (SFG.R), and HAMA scores were negatively correlated with CVR in SFG.R (r = -0.156, P = 0.016). Insula-SFG.R negative FC was significantly weaker in WMH patients with suspected or definite A/D. A model including CVR plus FC changes identified WMH-associated A/D with highest sensitivity and specificity. In contrast, NCs with A/D exhibited greater CVR in prefrontal cortex and stronger FC within the default mode network (DMN) and between the DMN and executive control network. LIMITATIONS This cross-sectional study requires validation by longitudinal and laboratory studies. CONCLUSIONS Impaired CVR in SFG.R and weaker negative FC between prefrontal cortex and insula may contribute to WMH-related A/D, providing potential diagnostic imaging markers and therapeutic targets.
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Affiliation(s)
- Lili Huang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Xin Liu
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China; Nanjing University of Science and Technology, 210094 Xuanwu District, Nanjing, China
| | - Yue Cheng
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Dan Yang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Yuting Mo
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Zhihong Ke
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Chenglu Mao
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Ying Chen
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China
| | - Jingwei Li
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China.
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Provincial Key Discipline of Neurology, Nanjing 210008, China; Nanjing Neurology Medical Center, Nanjing 210008, China.
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4
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Beran M, van Gennip AC, Stehouwer CD, Jansen JF, Gupta MD, Houben AJ, Berendschot TT, Webers CA, Wesselius A, Schalkwijk CG, Backes WH, de Jong JJ, van der Kallen CJ, van Greevenbroek MM, Köhler S, Vonk JM, Geerlings MI, Schram MT, van Sloten TT. Microvascular Dysfunction and Whole-Brain White Matter Connectivity: The Maastricht Study. J Am Heart Assoc 2024; 13:e9112. [PMID: 38240213 PMCID: PMC11056139 DOI: 10.1161/jaha.123.031573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole-brain white matter connectivity. METHODS AND RESULTS Cross-sectional data from The Maastricht Study, a Dutch population-based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light-induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017-0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures. CONCLUSIONS These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole-brain white matter connectivity.
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Affiliation(s)
- Magdalena Beran
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - April C.E. van Gennip
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Jacobus F.A. Jansen
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Monideepa D. Gupta
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Alfons J.H.M. Houben
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Tos T.J.M. Berendschot
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Carroll A.B. Webers
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Anke Wesselius
- Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Casper G. Schalkwijk
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Walter H. Backes
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Joost J.A. de Jong
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M.J. van Greevenbroek
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Alzheimer Centrum LimburgMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Jet M.J. Vonk
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Mirjam I. Geerlings
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of General PracticeAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized MedicineAmsterdamThe Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and SleepAmsterdamThe Netherlands
| | - Miranda T. Schram
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular Centre, Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Thomas T. van Sloten
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
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Scheuermann BC, Parr SK, Schulze KM, Kunkel ON, Turpin VG, Liang J, Ade CJ. Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032616. [PMID: 37930079 PMCID: PMC10727345 DOI: 10.1161/jaha.123.032616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS). METHODS AND RESULTS MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; P=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<0.01). CONCLUSIONS The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
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Affiliation(s)
| | - Shannon K. Parr
- Department of KinesiologyKansas State UniversityManhattanKSUSA
| | | | | | | | - Jia Liang
- Department of Biostatistics, St. Jude Children’s Research HospitalMemphisTNUSA
| | - Carl J. Ade
- Department of KinesiologyKansas State UniversityManhattanKSUSA
- Department of Physician’s Assistant Studies, Kansas State UniversityManhattanKSUSA
- Johnson Cancer Research CenterKansas State UniversityManhattanKSUSA
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6
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Barhwal KK, Parida B, Pattnaik J, Rowlo P, Mahakud S, Patra S, Rao BN, Mahapatra B. Reduced reward responsiveness in treatment resistant depression of middle-aged adults: Association with carotid artery stiffness and tetrahydrobiopterin. PLoS One 2023; 18:e0290784. [PMID: 37651359 PMCID: PMC10470903 DOI: 10.1371/journal.pone.0290784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
Nearly one third of the population diagnosed with major depressive disorder (MDD) fail to respond to two or more antidepressant drugs of adequate dose and duration. This necessitates identification of confounding psychological and physiological factors that could contribute to treatment resistant depression (TRD). The present longitudinal study investigated the influence of behavioural inhibition system (BIS) and behavioural approach system (BAS) in treatment resistance. Further, the association of depression severity with physiological factors contributing to arterial stiffness was also investigated. Baseline data was acquired from 101 middle-aged (36-56 years) patients on immediate diagnosis with MDD using DSM-V criteria. Follow ups were conducted at 06 months and 12 months during treatment. Psychological assessment battery at baseline and follow ups comprised of Hamilton depression rating (HAM-D) for depression severity, WHODAS-2 and BIS-BAS score. Atherosclerosis and central arterial stiffness were measured by intima-media thickness of internal carotid artery and brachial-ankle pulse wave velocity. Physiological factors influencing central vascular function viz., body-mass index, estimated glomerular filtration rate, HbA1c, central systolic and diastolic blood pressure, heart rate and tetrahydrobiopterin were also investigated. Our results show lower reward responsiveness (BAS-RR) and higher BIS scores in TRD patients along with differentially higher intima-media thickness of left internal carotid artery. Higher depression severity at all stages of the study was correlated with lower tetrahydrobiopterin and BAS-RR scores. We, therefore, suggest that vascular depression resulting due to increased intima-media thickness of left carotid artery and lower tetrahydrobiopterin could be contributing factors for treatment resistance in middle-aged MDD patients.
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Affiliation(s)
- Kalpana K. Barhwal
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Barsha Parida
- Department of Physiology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India
| | - Jigyansa Pattnaik
- Department of Psychiatry, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India
| | - Praveen Rowlo
- Department of Biomedical Sciences in Dentistry, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sudipta Mahakud
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Bodepudi N. Rao
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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7
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Lu Y, Kiechl SJ, Wang J, Xu Q, Kiechl S, Pechlaner R. Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants. EBioMedicine 2023; 92:104619. [PMID: 37229905 PMCID: PMC10327869 DOI: 10.1016/j.ebiom.2023.104619] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV). METHODS Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape. FINDINGS The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1-12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11-7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75-0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33-0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P < 0.0001) and differed more by country (highest in Poland, Russia, Iceland, France, and China; lowest in Spain, Belgium, Canada, Finland, and Argentina). High vs. other country income was associated with lower baPWV (-0.55 m/s, P = 0.048) and cfPWV (-0.41 m/s, P < 0.0001). INTERPRETATION China and other Asian countries featured high PWV, which by known associations with central blood pressure and pulse pressure may partly explain higher Asian risk for intracerebral haemorrhage and small vessel stroke. Reference values provided may facilitate use of PWV as a marker of vascular ageing, for prediction of vascular risk and death, and for designing future therapeutic interventions. FUNDING This study was supported by the excellence initiative VASCage funded by the Austrian Research Promotion Agency, by the National Science Foundation of China, and the Science and Technology Planning Project of Hunan Province. Detailed funding information is provided as part of the Acknowledgments after the main text.
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Affiliation(s)
- Yao Lu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China; School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Sophia J Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Jie Wang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qingbo Xu
- Centre for Clinical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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8
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Arcidiacono DM, Machia LV, Lefferts WK, Wolf DA, Heffernan KS. Social isolation and subclinical vascular pathways to cerebrovascular disease. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2023; 68:14-31. [PMID: 36825786 PMCID: PMC10275295 DOI: 10.1080/19485565.2023.2182274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Social isolation and lack of social support are risk factors for cardiovascular and cerebrovascular disease (CVD). This study explored the relationship between measures of social support and subclinical measures of CVD risk. 58 healthy adults ages 18 to 85 years participated in this study. The Berkman-Syme Social Network Inventory (SNI) was used to assess social isolation, with higher scores signifying less isolation. Social support was defined using the 12-Item Interpersonal Support Evaluation List (ISEL-12) with a higher score signifying higher social support. Subclinical CVD measures included carotid-femoral pulse wave velocity (cfPWV), carotid beta-stiffness index, and middle cerebral artery (MCA) pulsatility index. Path analysis models for both the SNI and ISEL appraisal domain predicting cfPWV and cerebrovascular pulsatility fit the data well. Path analyses showed significant direct paths from the SNI (β = -.363, t = -2.91) and ISEL appraisal domain (β = -.264, t = -2.05) to cfPWV. From cfPWV, both models revealed significant direct paths to carotid stiffness (β = .488, t = 4.18) to carotid pulse pressure (β = .311, t = 2.45) to MCA pulsatility (β = .527, t = 4.64). Social isolation and appraisal of social support are related to unfavorably higher aortic stiffness, with subsequent detrimental effects on cerebrovascular hemodynamic pulsatility.
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Affiliation(s)
| | - Laura V. Machia
- Department of Psychology and the Syracuse University, Syracuse New York
| | - Wesley K. Lefferts
- Department of Exercise Science, Syracuse University, Syracuse New York
- Department of Kinesiology, Iowa State University, Ames, Iowa
| | - Douglas A. Wolf
- Department of The Aging Studies Institute and the Center for Aging and Policy Studies, Syracuse University, Syracuse New York
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9
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He E, Liu M, Gong S, Fu X, Han Y, Deng F. White Matter Alterations in Depressive Disorder. Front Immunol 2022; 13:826812. [PMID: 35634314 PMCID: PMC9133348 DOI: 10.3389/fimmu.2022.826812] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Depressive disorder is the most prevalent affective disorder today. Depressive disorder has been linked to changes in the white matter. White matter changes in depressive disorder could be a result of impaired cerebral blood flow (CBF) and CBF self-regulation, impaired blood-brain barrier function, inflammatory factors, genes and environmental factors. Additionally, white matter changes in patients with depression are associated with clinical variables such as differential diagnosis, severity, treatment effect, and efficacy assessment. This review discusses the characteristics, possible mechanisms, clinical relevance, and potential treatment of white matter alterations caused by depressive disorders.
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10
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van Gennip ACE, Sedaghat S, Carnethon MR, Allen NB, Klein BEK, Cotch MF, Chirinos DA, Stehouwer CDA, van Sloten TT. Retinal Microvascular Caliber and Incident Depressive Symptoms: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2022; 191:843-855. [PMID: 34652423 PMCID: PMC9071571 DOI: 10.1093/aje/kwab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/05/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. The retina allows for visualization of a microvascular bed that shares similarities with the cerebral microvasculature. We investigated the associations between baseline retinal arteriolar and venular calibers (central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively) and incident depressive symptoms in the Multi-Ethnic Study of Atherosclerosis (MESA). We used longitudinal data on 4,366 participants (mean age = 63.2 years; 48.5% women, 28.4% Black) without baseline depressive symptoms. Depressive symptoms, defined as Center for Epidemiologic Studies Depression Scale score ≥16 and/or use of antidepressant medication, were determined between 2002 and 2004 (baseline; MESA visit 2) and at 3 follow-up examinations conducted every 1.5–2 years thereafter. Fundus photography was performed at baseline. After a mean follow-up period of 6.1 years, 21.9%
(n = 958) had incident depressive symptoms. After adjustment for sociodemographic, lifestyle, and cardiovascular factors, a 1–standard-deviation larger baseline CRVE was associated with a higher risk of depressive symptoms (hazard ratio = 1.10, 95% confidence interval: 1.02, 1.17), and a 1–standard-deviation larger baseline CRAE was not statistically significantly associated with incident
depressive symptoms (hazard ratio = 1.04, 95% confidence interval: 0.97, 1.11). In this study, larger baseline CRVE, but not CRAE, was associated with a higher incidence of depressive symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Thomas T van Sloten
- Correspondence to Dr. Thomas T. van Sloten, Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands (e-mail: )
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11
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Eriksson MD, Eriksson JG, Kautiainen H, Salonen MK, Mikkola TM, Kajantie E, Wasenius N, von Bonsdorff M, Korhonen P, Laine MK. Higher carotid-radial pulse wave velocity is associated with non-melancholic depressive symptoms in men - findings from Helsinki Birth Cohort Study. Ann Med 2021; 53:531-540. [PMID: 33769182 PMCID: PMC8011688 DOI: 10.1080/07853890.2021.1904277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression and cardiovascular disease (CVD) are major causes of global disease burden that are interrelated through mostly unknown mechanisms. We studied the relationship of melancholic and non-melancholic depressive symptoms with arterial stiffness, an important underlying mechanism of CVD. METHODS The Helsinki Birth Cohort Study recruited 683 previously extensively phenotyped subjects for this sub-study. Cross-sectional data along with responses regarding depressive symptoms were obtained for each participant. For evaluation of depressive symptoms, the Beck Depression Inventory (BDI)and subscales were used to measure melancholic and non-melancholic depressive symptoms. Arterial stiffness was assessed as pulse wave velocity (PWV) that was measured between the carotid and radial artery, and carotid and femoral artery. RESULTS Of the participants, 532 scored <10 on the BDI and were classified as not having depressive symptoms. Of the 151 participants that scored ≥10 on the BDI, 122 were classified as having non-melancholic depressive symptoms and 29 as having melancholic depressive symptoms. Men had higher carotid-radial PWV (crPWV) values than women (p < .001). A positive relationship between BDI scores and crPWV (p < .001) was found in men. We also found higher crPWV in men with non-melancholic depressive symptoms compared to all others. No such differences were found in women. DISCUSSION Arterial stiffness has a relationship with depressive symptoms and subtypes of depressive symptoms, at least in men. There is a significant relationship between higher PWV and non-melancholic depressive symptoms in men. Due to the intricate nature of the disease causality or directionality is impossible to infer solely based on this study. Further studies into the subtypes of depressive symptoms may be of benefit to understanding depression.KEY MESSAGESIt is known that arterial stiffness contributes to cardiovascular disease, and is associated with depression.Higher Beck Depression Inventory scores are associated with higher carotid-radial pulse wave velocity in men.Non-melancholic depressive symptoms are associated with higher carotid-radial pulse wave velocity in men.
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Affiliation(s)
- Mia D Eriksson
- Primary Health Care Unit, Helsinki University Hospital (HUS), Helsinki, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics & Gynecology and Human Potential Translational Research Programme Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland.,Department of Public Health Solutions, Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuija M Mikkola
- Folkhälsan Research Center, Helsinki, Finland.,Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Department of Public Health Solutions, Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Niko Wasenius
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikaela von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland.,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Päivi Korhonen
- Department of General Practice, Turku University Hospital and University of Turku, Turku, Finland
| | - Merja K Laine
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Janssen EPCJ, Köhler S, Geraets AFJ, Stehouwer CDA, Schaper NC, Sep SJS, Henry RMA, van der Kallen CJH, Schalkwijk CG, Koster A, Verhey FR, Schram MT. Low-grade inflammation and endothelial dysfunction predict four-year risk and course of depressive symptoms: The Maastricht study. Brain Behav Immun 2021; 97:61-67. [PMID: 34186200 DOI: 10.1016/j.bbi.2021.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/19/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Eveline P C J Janssen
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; Mondriaan Department of Old Age Psychiatry, Heerlen, the Netherlands.
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Anouk F J Geraets
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands.
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13
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Empana JP, Boutouyrie P, Lemogne C, Jouven X, van Sloten TT. Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives. Biol Psychiatry 2021; 90:214-225. [PMID: 34325805 DOI: 10.1016/j.biopsych.2021.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
Depression is common in older individuals and is associated with high disability and mortality. A major problem is treatment resistance: >50% of older patients do not respond to current antidepressants. Therefore, new effective interventions for prevention and treatment of depression in older individuals need to be developed, which requires a better understanding of the mechanisms underlying depression. The pathophysiology of depression is multifactorial and complex. Microvascular dysfunction may be an early and targetable mechanism in the development of depression, notably depression that initiates in late life (late-onset depression). Late-onset depression commonly co-occurs with other diseases or syndromes that may share a microvascular origin, including apathy, cognitive impairment, dementia, and stroke. Together, these disabilities may all be part of one large phenotype resulting from global cerebral microvascular dysfunction. In this review, we discuss the pathophysiology of microvascular dysfunction-related late-onset depression, summarize recent epidemiological evidence on the association between cerebral microvascular dysfunction and depression, and indicate potential drivers of cerebral microvascular dysfunction. We also propose the hypothesis that depression may be a manifestation of a larger phenotype of cerebral microvascular dysfunction, highlight potential therapeutic targets and interventions, and give directions for future research.
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Affiliation(s)
- Jean-Philippe Empana
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Thomas T van Sloten
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France; School for Cardiovascular Diseases Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
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14
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Zhang TH, Tang XC, Xu LH, Wei YY, Hu YG, Cui HR, Tang YY, Chen T, Li CB, Zhou LL, Wang JJ. Imbalance Model of Heart Rate Variability and Pulse Wave Velocity in Psychotic and Nonpsychotic Disorders. Schizophr Bull 2021; 48:154-165. [PMID: 34313787 PMCID: PMC8781329 DOI: 10.1093/schbul/sbab080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Patients with psychiatric disorders have an increased risk of cardiovascular pathologies. A bidirectional feedback model between the brain and heart exists widely in both psychotic and nonpsychotic disorders. The aim of this study was to compare heart rate variability (HRV) and pulse wave velocity (PWV) functions between patients with psychotic and nonpsychotic disorders and to investigate whether subgroups defined by HRV and PWV features improve the transdiagnostic psychopathology of psychiatric classification. METHODS In total, 3448 consecutive patients who visited psychiatric or psychological health services with psychotic (N = 1839) and nonpsychotic disorders (N = 1609) and were drug-free for at least 2 weeks were selected. HRV and PWV indicators were measured via finger photoplethysmography during a 5-minute period of rest. Canonical variates were generated through HRV and PWV indicators by canonical correlation analysis (CCA). RESULTS All HRV indicators but none of the PWV indicators were significantly reduced in the psychotic group relative to those in the nonpsychotic group. After adjusting for age, gender, and body mass index, many indices of HRV were significantly reduced in the psychotic group compared with those in the nonpsychotic group. CCA analysis revealed 2 subgroups defined by distinct and relatively homogeneous patterns along HRV and PWV dimensions and comprising 19.0% (subgroup 1, n = 655) and 80.9% (subgroup 2, n = 2781) of the sample, each with distinctive features of HRV and PWV functions. CONCLUSIONS HRV functions are significantly impaired among psychiatric patients, especially in those with psychosis. Our results highlight important subgroups of psychiatric patients that have distinct features of HRV and PWV which transcend current diagnostic boundaries.
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Affiliation(s)
- Tian Hong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xiao Chen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Li Hua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Yan Yan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Ye Gang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Hui Ru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Ying Ying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada,Labor and Worklife Program, Harvard University, Boston, MA, USA,Niacin (Shanghai) Technology Co., Ltd., Shanghai, China
| | - Chun Bo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Lin Lin Zhou
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Ji Jun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, PR China,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China,To whom correspondence should be addressed; Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai 200030, China; tel: +86-21-34773065, fax: +86-21-64387986, e-mail:
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15
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Alexopoulos GS. Mechanisms and Treatment of Late-Life Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:340-354. [PMID: 34690604 DOI: 10.1176/appi.focus.19304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
(Appeared originally in Translational Psychiatry 2019; 9:188).
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA
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16
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Liu Q, Fang J, Cui C, Dong S, Gao L, Bao J, Li Y, Ma M, Chen N, He L. Association of Aortic Stiffness and Cognitive Decline: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:680205. [PMID: 34248605 PMCID: PMC8261283 DOI: 10.3389/fnagi.2021.680205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Increased aortic stiffness has been found to be associated with cognitive function decline, but the evidence is still under debate. It is of great significance to elucidate the evidence in this debate to help make primary prevention decisions to slow cognitive decline in our routine clinical practice. Methods: Electronic databases of PubMed, EMBASE, and Cochrane Library were systematically searched to identify peer-reviewed articles published in English from January 1, 1986, to March 16, 2020, that reported the association between aortic stiffness and cognitive function. Studies that reported the association between aortic pulse wave velocity (PWV) and cognitive function, cognitive impairment, and dementia were included in the analysis. Results: Thirty-nine studies were included in the qualitative analysis, and 29 studies were included in the quantitative analysis. The aortic PWV was inversely associated with memory and processing speed in the cross-sectional analysis. In the longitudinal analysis, the high category of aortic PWV was 44% increased risk of cognitive impairment (OR 1.44; 95% CI 1.24–1.85) compared with low PWV, and the risk of cognitive impairment increased 3.9% (OR 1.039; 95% CI 1.005–1.073) per 1 m/s increase in aortic PWV. Besides, meta-regression analysis showed that age significantly increased the association between high aortic PWV and cognitive impairment risk. Conclusion: Aortic stiffness measured by aortic PWV was inversely associated with memory and processing speed and could be an independent predictor for cognitive impairment, especially for older individuals.
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Affiliation(s)
- Qian Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chaohua Cui
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lijie Gao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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17
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Nassir CMNCM, Ghazali MM, Hashim S, Idris NS, Yuen LS, Hui WJ, Norman HH, Gau CH, Jayabalan N, Na Y, Feng L, Ong LK, Abdul Hamid H, Ahamed HN, Mustapha M. Diets and Cellular-Derived Microparticles: Weighing a Plausible Link With Cerebral Small Vessel Disease. Front Cardiovasc Med 2021; 8:632131. [PMID: 33718454 PMCID: PMC7943466 DOI: 10.3389/fcvm.2021.632131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Cerebral small vessel disease (CSVD) represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger neuroinflammation and the subsequent neurodegenerative cascade. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, Alzheimer disease, and Parkinson disease. Despite being the most common neurodegenerative condition with cerebrocardiovascular axis, understanding about it remains poor. Interestingly, modifiable risk factors such as unhealthy diet including high intake of processed food, high-fat foods, and animal by-products are known to influence the non-neural peripheral events, such as in the gastrointestinal tract and cardiovascular stress through cellular inflammation and oxidation. One key outcome from such events, among others, includes the cellular activations that lead to elevated levels of endogenous cellular-derived circulating microparticles (MPs). MPs can be produced from various cellular origins including leukocytes, platelets, endothelial cells, microbiota, and microglia. MPs could act as microthrombogenic procoagulant that served as a plausible culprit for the vulnerable end-artery microcirculation in the brain as the end-organ leading to CSVD manifestations. However, little attention has been paid on the potential role of MPs in the onset and progression of CSVD spectrum. Corroboratively, the formation of MPs is known to be influenced by diet-induced cellular stress. Thus, this review aims to appraise the body of evidence on the dietary-related impacts on circulating MPs from non-neural peripheral origins that could serve as a plausible microthrombosis in CSVD manifestation as a precursor of neurodegeneration. Here, we elaborate on the pathomechanical features of MPs in health and disease states; relevance of dietary patterns on MP release; preclinical studies pertaining to diet-based MPs contribution to disease; MP level as putative surrogates for early disease biomarkers; and lastly, the potential of MPs manipulation with diet-based approach as a novel preventive measure for CSVD in an aging society worldwide.
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Affiliation(s)
| | - Mazira Mohamad Ghazali
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Sabarisah Hashim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nur Suhaila Idris
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Lee Si Yuen
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wong Jia Hui
- Neurobiology of Aging and Disease Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Haziq Hazman Norman
- Anatomy Unit, International Medical School (IMS), Management and Science University (MSU), Shah Alam, Malaysia
| | - Chuang Huei Gau
- Department of Psychology and Counselling, Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Nanthini Jayabalan
- Translational Neuroscience Lab, University of Queensland (UQ), Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Yuri Na
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Linqing Feng
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Lin Kooi Ong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, National Health and Medical Research Council (NHMRC), Heidelberg, VIC, Australia
| | - Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Haja Nazeer Ahamed
- Crescent School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, India
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Malaysia
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Moh MC, Low S, Ng TP, Ang SF, Ang K, Sum CF, Subramaniam T, Lim SC. Association between depressive symptoms and pulse wave velocity is mediated by increased adiposity in older adults with type 2 diabetes. J Psychiatry Neurosci 2021; 46:E176-E183. [PMID: 33464781 PMCID: PMC7955836 DOI: 10.1503/jpn.200080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Studies investigating the association between depression and aortic stiffness in older patients with type 2 diabetes are lacking. We postulated an association between depressive symptoms and aortic stiffness, and this relationship may be mediated by increased adiposity. METHODS We analyzed participants with type 2 diabetes aged 55 years or older (n = 958). We measured aortic stiffness using carotid-femoral pulse wave velocity (cut-off ≥ 12 m/s) using the tonometry method. We defined depressive symptoms as a score of greater than 5 on the Geriatric Depression Scale-15 (GDS-15). Adiposity indices we assessed were body mass index, waist circumference, waistto-height ratio, visceral fat area and fat mass. RESULTS Among the participants, 27.2% had aortic stiffness, of whom 6.5% had depressive symptoms. Score on the GDS-15 was correlated with pulse wave velocity, and both variables were correlated with the adiposity markers we analyzed (all p < 0.05). Depressive symptoms were associated with pulse wave velocity (B = 1.79, 95% confidence interval [CI] 0.83-2.75) or aortic stiffness (risk ratio 1.60, 95% CI 1.10-2.33) in the unadjusted model. The association persisted after controlling for demographics, duration of diabetes, glycated hemoglobin, comorbidities and medications. Further adjustment for visceral fat area and fat mass in separate models reduced the association between depressive symptoms and pulse wave velocity or aortic stiffness. Mediation models revealed that the mediation proportions of fat mass and visceral fat area on the association between depressive symptoms and pulse wave velocity were 11.8% and 9.7%, respectively. A preliminary analysis of longitudinal data (n = 184) showed similar findings. LIMITATIONS Causality cannot be inferred from the associations we observed. CONCLUSION Depressive symptoms are associated with elevated pulse wave velocity in older people with type 2 diabetes, and this relationship may be partially mediated by increased adiposity.
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Affiliation(s)
- Mei Chung Moh
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Serena Low
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Tze Pin Ng
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Su Fen Ang
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Keven Ang
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Chee Fang Sum
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Tavintharan Subramaniam
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
| | - Su Chi Lim
- From the Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (Moh, Low, S. Ang, K. Ang, Subramaniam, Lim); the Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore (Low, Sum, Subramaniam, Lim); the Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (Ng); and the Saw Swee Hock School of Public Health, National University Hospital, Singapore (Lim)
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Suri S, Chiesa ST, Zsoldos E, Mackay CE, Filippini N, Griffanti L, Mahmood A, Singh-Manoux A, Shipley MJ, Brunner EJ, Kivimäki M, Deanfield JE, Ebmeier KP. Associations between arterial stiffening and brain structure, perfusion, and cognition in the Whitehall II Imaging Sub-study: A retrospective cohort study. PLoS Med 2020; 17:e1003467. [PMID: 33373359 PMCID: PMC7771705 DOI: 10.1371/journal.pmed.1003467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aortic stiffness is closely linked with cardiovascular diseases (CVDs), but recent studies suggest that it is also a risk factor for cognitive decline and dementia. However, the brain changes underlying this risk are unclear. We examined whether aortic stiffening during a 4-year follow-up in mid-to-late life was associated with brain structure and cognition in the Whitehall II Imaging Sub-study. METHODS AND FINDINGS The Whitehall II Imaging cohort is a randomly selected subset of the ongoing Whitehall II Study, for which participants have received clinical follow-ups for 30 years, across 12 phases. Aortic pulse wave velocity (PWV) was measured in 2007-2009 (Phase 9) and at a 4-year follow-up in 2012-2013 (Phase 11). Between 2012 and 2016 (Imaging Phase), participants received a multimodal 3T brain magnetic resonance imaging (MRI) scan and cognitive tests. Participants were selected if they had no clinical diagnosis of dementia and no gross brain structural abnormalities. Voxel-based analyses were used to assess grey matter (GM) volume, white matter (WM) microstructure (fractional anisotropy (FA) and diffusivity), white matter lesions (WMLs), and cerebral blood flow (CBF). Cognitive outcomes were performance on verbal memory, semantic fluency, working memory, and executive function tests. Of 542 participants, 444 (81.9%) were men. The mean (SD) age was 63.9 (5.2) years at the baseline Phase 9 examination, 68.0 (5.2) at Phase 11, and 69.8 (5.2) at the Imaging Phase. Voxel-based analysis revealed that faster rates of aortic stiffening in mid-to-late life were associated with poor WM microstructure, viz. lower FA, higher mean, and radial diffusivity (RD) in 23.9%, 11.8%, and 22.2% of WM tracts, respectively, including the corpus callosum, corona radiata, superior longitudinal fasciculus, and corticospinal tracts. Similar voxel-wise associations were also observed with follow-up aortic stiffness. Moreover, lower mean global FA was associated with faster rates of aortic stiffening (B = -5.65, 95% CI -9.75, -1.54, Bonferroni-corrected p < 0.0125) and higher follow-up aortic stiffness (B = -1.12, 95% CI -1.95, -0.29, Bonferroni-corrected p < 0.0125). In a subset of 112 participants who received arterial spin labelling scans, faster aortic stiffening was also related to lower cerebral perfusion in 18.4% of GM, with associations surviving Bonferroni corrections in the frontal (B = -10.85, 95% CI -17.91, -3.79, p < 0.0125) and parietal lobes (B = -12.75, 95% CI -21.58, -3.91, p < 0.0125). No associations with GM volume or WMLs were observed. Further, higher baseline aortic stiffness was associated with poor semantic fluency (B = -0.47, 95% CI -0.76 to -0.18, Bonferroni-corrected p < 0.007) and verbal learning outcomes (B = -0.36, 95% CI -0.60 to -0.12, Bonferroni-corrected p < 0.007). As with all observational studies, it was not possible to infer causal associations. The generalisability of the findings may be limited by the gender imbalance, high educational attainment, survival bias, and lack of ethnic and socioeconomic diversity in this cohort. CONCLUSIONS Our findings indicate that faster rates of aortic stiffening in mid-to-late life were associated with poor brain WM microstructural integrity and reduced cerebral perfusion, likely due to increased transmission of pulsatile energy to the delicate cerebral microvasculature. Strategies to prevent arterial stiffening prior to this point may be required to offer cognitive benefit in older age. TRIAL REGISTRATION ClinicalTrials.gov NCT03335696.
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Affiliation(s)
- Sana Suri
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Scott T. Chiesa
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Enikő Zsoldos
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Clare E. Mackay
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Nicola Filippini
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Ludovica Griffanti
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Abda Mahmood
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, Paris, France
| | - Martin J. Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Eric J. Brunner
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - John E. Deanfield
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Klaus P. Ebmeier
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
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May RW, Cooper AN, Fincham FD. Prayer in Marriage to Improve Wellness: Relationship Quality and Cardiovascular Functioning. JOURNAL OF RELIGION AND HEALTH 2020; 59:2990-3003. [PMID: 31065881 DOI: 10.1007/s10943-019-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examined daily partner-focused petitionary prayer (PFPP) on relationship communication and quality as well as novel indices of cardiovascular functioning in a sample of 90 adults. PFPP was compared to waitlist and meditation conditions over a 4-week period. Aortic hemodynamics via pulse wave analysis were assessed before and after the intervention. Factorial repeated measures analyses indicated that for those in the prayer condition, there were significant improvements in coronary perfusion, decreased left ventricular work, and increased coronary blood flow. Additionally, the perceived positive aspects of one's relationship improved for those in the prayer condition. Similar changes did not occur in waitlist and meditation conditions. Findings suggest that daily PFPP improves relationship quality and cardiovascular efficiency via improving protective cardiovascular mechanisms. Practical implications are briefly discussed.
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Affiliation(s)
- Ross W May
- Family Institute, Florida State University, 120 Convocation Way, Tallahassee, FL, 32306-1491, USA.
| | - Ashley N Cooper
- Family Institute, Florida State University, 120 Convocation Way, Tallahassee, FL, 32306-1491, USA
| | - Frank D Fincham
- Family Institute, Florida State University, 120 Convocation Way, Tallahassee, FL, 32306-1491, USA
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21
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Estimated pulse wave velocity is associated with residual-specific mortality: findings from the National Health and Nutrition Examination Survey. J Hypertens 2020; 39:698-702. [PMID: 33186319 DOI: 10.1097/hjh.0000000000002691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Estimated pulse wave velocity (ePWV) is emerging as a predictor of cardiovascular and all-cause mortality. Approximately one-third of all deaths are not related to the top nine causes of mortality as defined by the CDC. We examined the association of ePWV with residual-specific mortality in a large sample of US adults. METHODS Data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) were used (n = 13 909 adults between the ages of 18-85 years), with follow-up through 2011 (mean follow-up, 104 months). ePWV was calculated from a regression equation using age and mean blood pressure. RESULTS After adjusting for age, pulse pressure, race/ethnicity, blood lipids, glucose, C-reactive protein, eGFR, smoking, self-reported physical activity, history of hypertension and diabetes, for every 1 m/s increase in ePWV, there was a 17% increased risk of residual-specific mortality (hazard ratio = 1.17, 95% CI = 1.02-1.36; P = 0.03). If using a previously recommended clinical cut-point of 10 m/s, those with an elevated ePWV had an increased risk of 57% (hazard ratio = 1.57; 95% CI = 0.98-2.50; P = 0.06). CONCLUSION ePWV is associated with residual-specific mortality in a nationally representative sample of adults.
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Wang J, Tillin T, Hughes AD, Richards M, Sattar N, Park C, Chaturvedi N. Subclinical macro and microvascular disease is differently associated with depressive symptoms in men and women: Findings from the SABRE population-based study. Atherosclerosis 2020; 312:35-42. [PMID: 32971394 PMCID: PMC7594642 DOI: 10.1016/j.atherosclerosis.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/04/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS Mechanisms underlying the association between cardiovascular disease (CVD) and depression are unknown, and sex differences understudied. We investigated associations between a comprehensive set of measures of macro and microvascular disease and depressive symptoms in older men and women. METHODS We performed cross-sectional analyses of the SABRE (Southall And Brent REvisited) population-based study. Participants (1396) attended clinic between 2008 and 2011 for assessment of subclinical macrovascular (carotid ultrasound, echocardiography, cerebral magnetic resonance imaging) and microvascular (retinopathy, nephropathy) disease, and depression. RESULTS Mean age of 1396 participants was 69.5 years, and 76.2% were male. The median (interquartile range) of depression score was 1 [0, 2] for men and 1 [0, 3] for women. All measures of subclinical macro and microvascular disease were adversely associated with depressive symptoms, even when known CVD was excluded. Physical activity partly explained some of these relationships. The association between left atrial dimension index (LADI), a measure of chronic elevated left ventricular filling pressure, and depressive symptoms was stronger in women (regression coefficient 0.23 [95% CI 0.11, 0.35]) than men (0.07 [-0.01, 0.15]), p for interaction 0.06, on multivariable adjustment. CONCLUSIONS Subclinical macro and microvascular disease is associated with depressive symptoms, even in the absence of established CVD. These were in part accounted for by physical activity. We observed stronger association between LADI and depressive symptoms in women than in men. The beneficial role of physical activity in abrogating the association between subclinical CVD and depression warrants further investigation.
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Affiliation(s)
- Jingyi Wang
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Oikonomou E, Vogiatzi G, Lazaros G, Tsalamandris S, Goliopoulou A, Mystakidou V, Theofilis P, Christoforatou E, Chasikidis C, Tousoulis D. Relationship of depressive symptoms with arterial stiffness and carotid atherosclerotic burden in the Corinthia study. QJM 2020; 113:633-642. [PMID: 32125429 DOI: 10.1093/qjmed/hcaa079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/26/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It has been long hypothesized that emotional factors and depression may play role in the development of cardiovascular diseases. AIM The aim of this study was to examine the association between depression, arterial stiffness and atheromatic burden in carotid arteries. DESIGN AND METHODS Corinthia study is a cross-sectional epidemiological study conducted in subjects aged 40-99 years, inhabitants of the homonym region of Greece. Intima media thickness (IMT) was measured in the left and right common carotid artery, carotid bulb and internal carotid artery. The average of the measurements (mean IMT) and the maximum IMT were determined as the representative value of carotid atherosclerosis burden. Pulse wave velocity was used to evaluate arterial stiffness. The Zung Self-Rating Depression Scale was used to evaluate depressive symptoms in subjects <65 years and the Geriatric Depression Scale in those >65 years. RESULTS In this analysis, we included data from 1510 participants. In older subjects (i.e. >65 years), maximum IMT was significantly increased in subjects with depression compared to those without (1.57 ± 0.97 mm vs. 1.74 ± 1.05 mm, P = 0.04). Similarly, the prevalence of atheromatic plaques was higher in subjects with depression (46% vs. 34%, P = 0.005). In the younger subgroup (<65years), there was no difference in mean and maximum IMT. Pulse wave velocity was found higher in the presence of depression (8.35 ± 2.36m/s vs. 7.88 ± 1.77m/s, P = 0.007). No differences emerged for the rest of the variables assessed in the individual subgroups. CONCLUSIONS There is an age-dependent association between depression, arterial stiffness and carotid atheromatic burden highlighting the interplay between cardiovascular diseases and emotional status.
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Affiliation(s)
- E Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - A Goliopoulou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - V Mystakidou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - P Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - E Christoforatou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - C Chasikidis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Jeon YJ, Cho SMJ, Lee YJ, Kim HC, Jung SJ. Depressive symptoms, its sub-factors, and augmentation index: the modifying effects according to inflammatory markers. J Affect Disord 2020; 272:380-387. [PMID: 32553381 DOI: 10.1016/j.jad.2020.03.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/25/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
Background This study aimed to investigate the association between depression and the augmentation index (AIx), and to further investigate whether there is a difference in this association according to the patients' inflammatory status. Methods This study included 458 men and 815 women (mean age: 49.35 years), a community-dwelling and middle-aged Korean population. The Korean version of the Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms. Arterial stiffness was evaluated via an AIx normalized to 75 beats/min. We confirmed two factors from BDI-II after conducting a factor analysis. Multiple regression models were used after adjusting for socio-demographic factors, lifestyle factors, systolic blood pressure, diabetes history, and body mass index. We further stratified the data according to inflammatory biomarkers with cutoffs of the 75th percentile. Results There was a significant positive association between the BDI-II score and arterial stiffness (ß= 0.09, p-value=0.037). In women, the somatic-affective factor showed a stronger positive association (ß= 0.20, p-value=0.018) with arterial stiffness than the cognitive factor (ß= 0.12, p-value=0.148). There was no significant association in men (ß= -0.01, p-value=0.943). In subgroup analyses, women showed significant positive associations between the somatic affective factor of depressive symptoms on and arterial stiffness according to both inflammatory markers (IL-6: ß= 0.17, p-value=0.039; hs-CRP: ß= 0.17, p-value=0.094) Limitations The design of the cross-sectional study limits causal interpretation. Conclusion Depression and its somatic-affective factor were positively associated with arterial stiffness in women. Inflammatory status may be involved in modifying the association between depressive symptoms, its sub-factors, and AIx.
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Affiliation(s)
- Ye Jin Jeon
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - So Mi Jemma Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Yu Jin Lee
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea; Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Jae Jung
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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25
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Lai H, Wang S, Zhao Y, Qiu C, Gong Q. Neurostructural correlates of optimism: Gray matter density in the putamen predicts dispositional optimism in late adolescence. Hum Brain Mapp 2020; 41:1459-1471. [PMID: 31816149 PMCID: PMC7267983 DOI: 10.1002/hbm.24888] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
Dispositional optimism reflects one's generalized positive expectancies for future outcomes and plays a crucial role in personal developmental outcomes and health (e.g., counteracting related mental disorders such as depression and anxiety). Increasing evidence has suggested that extraversion is an important personality factor contributing to dispositional optimism. However, less is known about the association between dispositional optimism and brain structure and the role of extraversion in this association. Here, we examined these issues in 231 healthy high school students aged 16 to 20 years (110 males, mean age = 18.48 years, SD = 0.54) by estimating regional gray matter density (rGMD) using a voxel-based morphometry method via structural magnetic resonance imaging. Whole-brain regression analyses revealed a significant positive correlation between dispositional optimism and the rGMD of the bilateral putamen after adjusting for age, sex, family socioeconomic status (SES), general intelligence, and total gray matter volume (TGMV). Moreover, prediction analyses using fourfold balanced cross-validation combined with linear regression confirmed a significant connection between dispositional optimism and putamen density after adjusting for age, sex, and family SES. More importantly, subsequent mediation analysis showed that extraversion may account for the association between putamen density and dispositional optimism after adjusting for age, sex, family SES, general intelligence, TGMV, and the other four Big Five personality traits. Taken together, the current study provides new evidence regarding the neurostructural basis underlying dispositional optimism in adolescents and underscores the importance of extraversion as an essential personality factor for dispositional optimism acquisition.
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Affiliation(s)
- Han Lai
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
- Department of RadiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011)West China Hospital of Sichuan UniversityChengduChina
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
- Department of RadiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011)West China Hospital of Sichuan UniversityChengduChina
| | - Yajun Zhao
- School of Sociology and PsychologySouthwest Minzu UniversityChengduChina
| | - Chen Qiu
- Department of Psychology, The Faculty of Social ScienceThe University of Hong KongPokfulamHong Kong
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
- Department of RadiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011)West China Hospital of Sichuan UniversityChengduChina
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van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol 2020; 8:325-336. [PMID: 32135131 DOI: 10.1016/s2213-8587(19)30405-x] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022]
Abstract
Adults with type 2 diabetes are at an increased risk of developing certain brain or mental disorders, including stroke, dementia, and depression. Although these disorders are not usually considered classic microvascular complications of diabetes, evidence is growing that microvascular dysfunction is one of the key underlying mechanisms. Microvascular dysfunction is a widespread phenomenon in people with diabetes, including effects on the brain. Cerebral microvascular dysfunction is also apparent in adults with prediabetes, suggesting that cerebral microvascular disease processes start before the onset of diabetes. The microvasculature is involved in the regulation of many cerebral processes that when impaired predispose to lacunar and haemorrhagic stroke, cognitive dysfunction, and depression. Main drivers of diabetes-related cerebral microvascular dysfunction are hyperglycaemia, obesity and insulin resistance, and hypertension. Increasing amounts of data from observational studies suggest that diabetes-related microvascular dysfunction is associated with a higher risk of stroke, cognitive dysfunction, and depression. Cerebral outcomes in diabetes might be improved following treatments targeting the pathways through which diabetes damages the microcirculation. These treatments might include drugs that reduce dicarbonyl compounds, augment cerebral insulin signalling, or improve blood-brain barrier permeability and cerebral vasoreactivity.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sanaz Sedaghat
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.
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Peng L, Bi S, Liu X, Long T, Zhao Y, Li F, Yang T, Zhang C. Association between depressive symptoms and arterial stiffness: a cross-sectional study in the general Chinese population. BMJ Open 2020; 10:e033408. [PMID: 32114467 PMCID: PMC7050321 DOI: 10.1136/bmjopen-2019-033408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the independent relationship between depressive symptoms and arterial stiffness in the general Chinese population, and to explore possible interactive factors in the relationship. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS Consecutive participants who received routine health physical examination in an affiliated hospital of a comprehensive university in Hunan Province, China, between September 2013 and March 2014 were examined. After exclusion of subjects not meeting the criteria, a total of 1334 subjects aged 22-77 years were recruited for final analysis. MEASURES The Patient Health Questionnaire-9 was employed to assess the degree of depressive symptoms: 0-4 no depressive symptoms, 5-9 mild depressive symptoms and 10-27 moderate to severe depressive symptoms. Brachial-ankle pulse wave velocity (baPWV) was measured to determine arterial stiffness. RESULTS There was a slight increase in baPWV across elevated degrees of depressive symptoms (p=0.025). Multivariate linear regression analysis revealed that mild depressive symptoms and moderate to severe depressive symptoms were independently associated with baPWV compared with no depressive symptoms after adjusting for baseline confounders (beta-coefficient: 40.3, 95% CI 6.6 to 74.1; beta-coefficient: 87.7, 95% CI 24.0 to 151.5, respectively). Further stratified analyses indicated that the relationship between degree of depressive symptoms and baPWV was predominant in subjects who had normal or normal-high blood pressure, or combined with hypertension (p for interaction=0.016), or in subjects with diabetes mellitus (p for interaction=0.004), examined in multivariate linear regressions. In addition, after adjustment, a significant association between moderate to severe depressive symptoms and baPWV was also found in female subjects younger than 60 years, although the interactive effect was not significant (p for interaction=0.056). CONCLUSIONS Depressive symptoms are independently associated with arterial stiffness, especially in subjects whose blood pressures are beyond the optimal range and combined with diabetes mellitus.
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Affiliation(s)
- Liming Peng
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sisi Bi
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangwei Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianyi Long
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yixia Zhao
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fei Li
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianlun Yang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenglong Zhang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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28
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Wouts L, van Kessel M, Beekman AT, Marijnissen RM, Oude Voshaar RC. Empirical support for the vascular apathy hypothesis: A structured review. Int J Geriatr Psychiatry 2020; 35:3-11. [PMID: 31617249 PMCID: PMC6916153 DOI: 10.1002/gps.5217] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A systematic review of the relationship between subclinical small vessel disease (SSVD) in the general population and apathy to examine the hypothesis that apathy has a vascular basis. METHODS We searched for studies on associations between apathy and SSVD, operationalized as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness, and perivascular spaces, while also peripheral proxies for SSVD were considered, operationalized as ankle brachial pressure index (ABI), intima media thickness, arterial stiffness, cardio-femoral pulse wave velocity, hypertension, or cardiovascular disease. Only eligible retrospective and prospective observational studies conducted in the general population were included. RESULTS The 14 studies eligible for review examined the associations between apathy and hypertension (3), ABI (1), arterial stiffness (1), cardiovascular disease (2), WMH (3), white matter diffusivity (2), cerebral microbleeds (1), or cortical thickness (3). Arterial stiffness and white matter diffusivity were not related to apathy, while the associations with cortical thickness were contradictory. Cross-sectional studies in the general population did find evidence of apathy being associated with WMH, CM, cardiovascular disease, hypertension, and ABI, and cardiovascular disease was prospectively associated with apathy. The methodologies of the studies reviewed were too heterogeneous to perform meta-analyses. CONCLUSIONS Although more prospective evidence is needed and vascular depression needs to be controlled for, cardiovascular disease, hypertension, and ABI as proxies for SSVD, and WMH and cerebral microbleeds as direct measures of SSVD have been found to be associated with apathy in the general population, supporting the hypothesis of vascular apathy.
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Affiliation(s)
- Lonneke Wouts
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | | | - Aartjan T.F. Beekman
- GGZinGeestMental Health InstituteAmsterdamThe Netherlands,Department of PsychiatryAmsterdam University Medical CentreAmsterdamThe Netherlands
| | - Radboud M. Marijnissen
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
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29
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Abstract
Small vessel disease (SVD) refers to conditions where damage to arterioles and capillaries is predominant, leading to reduced, or interrupted perfusion of the affected organ. Data suggest that when this condition is evident in any organ, it is already systemic in its occurrence and consequences. SVD affects primarily organs that receive significant portions of cardiac output such as the brain, the kidney, and the retina. Thus, SVD is a major etiologic cause in debilitating conditions such as renal failure, blindness, lacunar infarcts, and dementia. The factors that lead to this devastating condition include all the known vascular risk factors when they are not strictly controlled, but lifestyles that include sedentary existence, obesity, and poor sleep patterns are also recognized drivers of SVD. In addition, depression is now recognized as a vascular risk factor. Inflammation is a mediator of SVD, but it is not known which factor(s) predominate in its etiology. This article emphasizes the need for more investigations to define this link further and suggests clinical and societal responses that might reduce the major impacts of this condition on populations.
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Affiliation(s)
- Antoine M Hakim
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, University of Ottawa, Ottawa, ON, Canada
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30
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Alexopoulos GS. Mechanisms and treatment of late-life depression. Transl Psychiatry 2019; 9:188. [PMID: 31383842 PMCID: PMC6683149 DOI: 10.1038/s41398-019-0514-6] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023] Open
Abstract
Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson's disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.
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Affiliation(s)
- George S. Alexopoulos
- 000000041936877Xgrid.5386.8Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605 USA
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31
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de Havenon A, Wong KH, Elkhetali A, McNally JS, Majersik JJ, Rost NS. Carotid Artery Stiffness Accurately Predicts White Matter Hyperintensity Volume 20 Years Later: A Secondary Analysis of the Atherosclerosis Risk in the Community Study. AJNR Am J Neuroradiol 2019; 40:1369-1373. [PMID: 31248859 DOI: 10.3174/ajnr.a6115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Arterial stiffness is a biomarker of cerebrovascular disease and dementia risk. Studies have shown an association between carotid artery stiffness and increased white matter hyperintensity volume and, as a result, reduced total brain volume on MR imaging, but none have had prolonged follow-up to fully evaluate the slow change seen in white matter hyperintensity volume and total brain volume with time. Our objective was to determine whether common carotid artery stiffness on sonography accurately predicts white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. MATERIALS AND METHODS We performed a secondary analysis of the Atherosclerosis Risk in the Community study to compare 5 measurements of carotid artery stiffness, including strain, distensibility, compliance, Stiffness index, and pressure-strain elastic modulus, with the white matter hyperintensity volume and total brain volume on a follow-up MR imaging using linear regression. RESULTS We included 1402 patients enrolled in the Atherosclerosis Risk in the Community study. There was a significant relationship between increasing carotid artery stiffness and both higher white matter hyperintensity volume and lower total brain volume on MR imaging, measured at a mean of 21.5 years later. In multivariable linear regression models, the carotid strain, distensibility, Stiffness index, and pressure-strain elastic modulus were associated with white matter hyperintensity volume. Only compliance was associated with total brain volume in the multivariate models. CONCLUSIONS Sonography measurements of carotid artery stiffness are predictive of white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. The association is more robust for white matter hyperintensity volume than total brain volume. These findings support the role of arterial stiffness as a method for identifying patients at risk of developing white matter hyperintensity volume and as a potential mechanism leading to small-artery disease of the brain.
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Affiliation(s)
- A de Havenon
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - K-H Wong
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - A Elkhetali
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - J S McNally
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - J J Majersik
- From the Department of Neurology (A.d.H., K.-H.W., A.E., J.S.M., J.J.M.), University of Utah, Salt Lake City, Utah
| | - N S Rost
- Harvard Medical School (N.S.R.). Boston, Massachusetts
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32
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van Sloten TT, Boutouyrie P, Tafflet M, Offredo L, Thomas F, Guibout C, Climie RE, Lemogne C, Pannier B, Laurent S, Jouven X, Empana JP. Carotid Artery Stiffness and Incident Depressive Symptoms: The Paris Prospective Study III. Biol Psychiatry 2019; 85:498-505. [PMID: 30409381 DOI: 10.1016/j.biopsych.2018.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 09/11/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Arterial stiffness may contribute to late-life depression via cerebral microvascular damage, but evidence is scarce. No longitudinal study has evaluated the association between arterial stiffness and risk of depressive symptoms. Therefore, we investigated the association between carotid artery stiffness and incident depressive symptoms in a large community-based cohort study. METHODS This longitudinal study included 7013 participants (mean age 59.7 ± 6.3 years; 35.8% women) free of depressive symptoms at baseline. Carotid artery stiffness (high-resolution echo tracking) was determined at baseline. Presence of depressive symptoms was determined at baseline and at 4 and 6 years of follow-up, and was defined as a score ≥7 on the validated Questionnaire of Depression, Second Version, Abridged and/or new use of antidepressant medication. Logistic regression and generalized estimating equations were used. RESULTS In total, 6.9% (n = 484) of the participants had incident depressive symptoms. Individuals in the lowest tertile of carotid distensibility coefficient (indicating greater carotid artery stiffness) compared with those in the highest tertile had a higher risk of incident depressive symptoms (odds ratio: 1.43; 95% confidence interval: 1.10-1.87), after adjustment for age, sex, living alone, education, lifestyle, cardiovascular risk factors, and baseline Questionnaire of Depression, Second Version, Abridged scores. Results were qualitatively similar when we used carotid Young's elastic modulus as a measure of carotid stiffness instead of carotid distensibility coefficient, and when we used generalized estimating equations instead of logistic regression. CONCLUSIONS Greater carotid stiffness is associated with a higher incidence of depressive symptoms. This supports the hypothesis that carotid stiffness may contribute to the development of late-life depression.
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Affiliation(s)
- Thomas T van Sloten
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Pierre Boutouyrie
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Pharmacology, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Muriel Tafflet
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Lucile Offredo
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | | | - Catherine Guibout
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Rachel E Climie
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
| | - Cédric Lemogne
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Psychiatry and Neuroscience Center, U894, French Institute of Health and Medical Research, Paris, France; Department of Psychiatry, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Bruno Pannier
- Preventive and Clinical Investigation Center, Paris, France
| | - Stéphane Laurent
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Pharmacology, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Xavier Jouven
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Jean-Philippe Empana
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
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33
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Alexopoulos GS. Promoting Health Behaviors For Aging Persons. Am J Geriatr Psychiatry 2019; 27:237-240. [PMID: 30679021 DOI: 10.1016/j.jagp.2018.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022]
Affiliation(s)
- George S Alexopoulos
- Department of Psychiatry (GSA), Weill Cornell Medical College, White Plains, NY.
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34
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Mitchell GF. Aortic stiffness, pressure and flow pulsatility, and target organ damage. J Appl Physiol (1985) 2018; 125:1871-1880. [PMID: 30359540 PMCID: PMC6842890 DOI: 10.1152/japplphysiol.00108.2018] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/17/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023] Open
Abstract
Measures of aortic stiffness and pressure and flow pulsatility have emerged as correlates of and potential contributors to cardiovascular disease, dementia, and kidney disease. Higher aortic stiffness and greater pressure and flow pulsatility are associated with excessive pulsatile load on the heart, which increases mass and reduces global longitudinal strain of the left ventricle. Excessive stiffness and pulsatility are also associated with microvascular lesions in high-flow organs, such as the brain and kidney, suggesting that small vessels in these organs are damaged by pulsatility. This brief review will summarize evidence relating aortic stiffness to cardiovascular, brain, and kidney disease.
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Affiliation(s)
- Gary F Mitchell
- Cardiovascular Engineering, Incorporated, Norwood, Massachusetts
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35
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Hildreth KL, Ozemek C, Kohrt WM, Blatchford PJ, Moreau KL. Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life. Menopause 2018; 25:1011-1019. [PMID: 29634636 PMCID: PMC6103796 DOI: 10.1097/gme.0000000000001112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages. METHODS Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses. RESULTS Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = -0.27 to -0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = -0.08, -0.03, P = 0.35). CONCLUSIONS Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
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Affiliation(s)
- Kerry L. Hildreth
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
| | - Cemal Ozemek
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago
| | - Wendy M. Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
| | - Patrick J. Blatchford
- Colorado Biostatistical Consortium, Colorado School of Public Health, University of Colorado Denver
| | - Kerrie L. Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
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36
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van Sloten T, Schram M. Understanding depression in type 2 diabetes: a biological approach in observational studies. F1000Res 2018; 7. [PMID: 30135724 PMCID: PMC6092903 DOI: 10.12688/f1000research.13898.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 12/27/2022] Open
Abstract
Depression is twice as common in type 2 diabetes as in the general population and is associated with adverse health outcomes. Growing evidence suggest that type 2 diabetes and depression share biological mechanisms. This brief commentary discusses current understanding of shared biological pathways, focussing on hyperglycaemia, (micro)vascular dysfunction, and low-grade inflammation. Although there is accumulating evidence that these pathways are involved in the link between type 2 diabetes and depression, direct evidence of their temporal associations is lacking because of a paucity of longitudinal studies that focus on the pathobiology of both type 2 diabetes and depression.
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Affiliation(s)
- Thomas van Sloten
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht , Netherlands.,Departments of Epidemiology and Arterial Mechanics, INSERM U970 and Paris-Cardiovascular Research Center, Paris, France
| | - Miranda Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht , Netherlands.,Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht , Netherlands
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37
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Wu Y, Sun D, Wang B, Li Y, Ma Y. The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis. Eur J Prev Cardiol 2018. [PMID: 29537293 DOI: 10.1177/2047487318764158] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives The relationship of depressive symptoms and subclinical atherosclerosis remains controversial. We performed a systematic review and meta-analysis to evaluate the effect of depressive symptoms on the functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and flow-mediated vasodilation (FMD). Methods A systematic literature search was performed electronically. Studies relating IMT, PWV or FMD to depressive symptoms were included. Standard/weighted mean differences (SMD/WMD) and corresponding 95% confidence intervals (95% CIs) were pooled in overall and subgroup analyses (age, sex, depression diagnosis, region, study design, site measured and sample size). Sensitivity analysis and publication bias were also conducted. Results Thirty-eight articles involving 5947 patients with depressive symptoms and 34,423 controls without depressive symptoms were included. Compared with controls without depressive symptoms, patients with depressive symptoms showed a significantly thicker IMT (SMD (95% CI) = 0.137 (0.047–0.227), p = 0.003), a higher PWV (SMD (95% CI) = 0.216 (0.139–0.293), p < 0.001) and a lower FMD (WMD (95% CI) = –2.554 (–3.709 to –1.399), p < 0.001). When analyzing subgroups with age and female ratio, all results were still significant ( p < 0.05) except IMT and FMD in age < 50 years subgroups ( p > 0.05). There was no statistical significance in sensitivity analysis and publication bias ( p > 0.05). Conclusions Depressive symptoms contributed toward subclinical atherosclerosis, and resulted in impaired functional and structural markers of subclinical atherosclerosis, which holds great promise in early prevention of cardiovascular disease.
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Affiliation(s)
- Yupeng Wu
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bin Wang
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yanfeng Li
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
| | - Yi Ma
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, China
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Onete V, Henry RM, Sep SJS, Koster A, van der Kallen CJ, Dagnelie PC, Schaper N, Köhler S, Reesink K, Stehouwer CDA, Schram MT. Arterial stiffness is associated with depression in middle-aged men - the Maastricht Study. J Psychiatry Neurosci 2018; 43. [PMID: 29481318 PMCID: PMC5837883 DOI: 10.1503/jpn.160246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Arterial stiffening may underlie the association between depression and cardiovascular disease (CVD), but reported data are inconsistent. We investigated the associations between aortic stiffness and major depressive disorder (MDD) and depressive symptoms, and whether these differed by sex and age. METHODS We measured carotid to femoral pulse wave velocity (cfPWV) using applanation tonometry, and we assessed depression using the Mini-International Neuropsychiatric Interview (MINI) and the Patient Health Questionnaire-9 (PHQ-9) in a cohort of participants from The Maastricht Study. Logistic and negative binominal models were adjusted for age, type 2 diabetes mellitus (T2DM), mean arterial pressure (MAP) and CVD risk factors. RESULTS We included 2757 participants in our analyses (48.8% men, mean age 59.8 ± 8.1 yr, 27% T2DM). We found that cfPWV was associated with MDD in men (fully adjusted odds ratio [OR] 2.36, 95% confidence interval [CI] 1.45-3.84), but not in women (OR 1.57, 95% CI 0.93-2.66), aged 60 years or younger. The ORs were not significant in individuals older than 60 years (men: OR 1.03, 95% CI 0.63-1.68; women: OR 0.64, 95% CI 0.32-1.31). Similarly, cfPWV was associated with a higher PHQ-9 score in men (rate ratio 1.28, 95% CI 1.09-1.52), but not in women (rate ratio 1.11, 95% CI 0.99-1.23), aged 60 years or younger. Associations were not significant in individuals older than 60 years (men: rate ratio 0.96, 95% CI 0.84-1.08; women: rate ratio 1.00, 95% CI 0.90-1.12). LIMITATIONS We cannot rule out reversed causation in this cross-sectional study. CONCLUSION Greater aortic stiffness is associated with MDD and depressive symptoms among middle-aged men and to a lesser extent in women, whereas this association was not observed in old age.
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Affiliation(s)
- Veronica Onete
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Ronald M Henry
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Simone J S Sep
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Annemarie Koster
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Carla J van der Kallen
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Pieter C Dagnelie
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Nicolaas Schaper
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Sebastian Köhler
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Koen Reesink
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Coen D A Stehouwer
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Miranda T Schram
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
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Onete V, Henry RM, Sep SJS, Koster A, van der Kallen CJ, Dagnelie PC, Schaper N, Köhler S, Reesink K, Stehouwer CDA, Schram MT. Arterial stiffness is associated with depression in middle-aged men - the Maastricht Study. J Psychiatry Neurosci 2018; 43:111-119. [PMID: 29481318 PMCID: PMC5837883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Arterial stiffening may underlie the association between depression and cardiovascular disease (CVD), but reported data are inconsistent. We investigated the associations between aortic stiffness and major depressive disorder (MDD) and depressive symptoms, and whether these differed by sex and age. METHODS We measured carotid to femoral pulse wave velocity (cfPWV) using applanation tonometry, and we assessed depression using the Mini-International Neuropsychiatric Interview (MINI) and the Patient Health Questionnaire-9 (PHQ-9) in a cohort of participants from The Maastricht Study. Logistic and negative binominal models were adjusted for age, type 2 diabetes mellitus (T2DM), mean arterial pressure (MAP) and CVD risk factors. RESULTS We included 2757 participants in our analyses (48.8% men, mean age 59.8 ± 8.1 yr, 27% T2DM). We found that cfPWV was associated with MDD in men (fully adjusted odds ratio [OR] 2.36, 95% confidence interval [CI] 1.45-3.84), but not in women (OR 1.57, 95% CI 0.93-2.66), aged 60 years or younger. The ORs were not significant in individuals older than 60 years (men: OR 1.03, 95% CI 0.63-1.68; women: OR 0.64, 95% CI 0.32-1.31). Similarly, cfPWV was associated with a higher PHQ-9 score in men (rate ratio 1.28, 95% CI 1.09-1.52), but not in women (rate ratio 1.11, 95% CI 0.99-1.23), aged 60 years or younger. Associations were not significant in individuals older than 60 years (men: rate ratio 0.96, 95% CI 0.84-1.08; women: rate ratio 1.00, 95% CI 0.90-1.12). LIMITATIONS We cannot rule out reversed causation in this cross-sectional study. CONCLUSION Greater aortic stiffness is associated with MDD and depressive symptoms among middle-aged men and to a lesser extent in women, whereas this association was not observed in old age.
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Affiliation(s)
- Veronica Onete
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Ronald M Henry
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Simone J S Sep
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Annemarie Koster
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Carla J van der Kallen
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Pieter C Dagnelie
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Nicolaas Schaper
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Sebastian Köhler
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Koen Reesink
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Coen D A Stehouwer
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
| | - Miranda T Schram
- From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler)
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Skibitsky VV, Fendrikova AV, Skibitsky AV. [Efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders]. TERAPEVT ARKH 2017; 89:22-28. [PMID: 28914847 DOI: 10.17116/terarkh201789822-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders (DD). MATERIAL AND METHODS 153 patients with uncontrolled hypertension were examined, of whom 82 patients were diagnosed with mild and moderate DD. A combination of perindopril 10 mg/day, indapamide SR 1.5 mg/day, and amlodipine at an initial dose of 5 mg/day was given to patients with hypertension and DD. After 4 weeks of treatment, if target blood pressure (BP) levels could not be achieved, the dose of amlodipine was increased up to 10 mg/day. General clinical examination and 24-hour BP monitoring (BPM) were performed in all the patients at baseline and in the patients with DD also after 24 weeks of therapy. The traditional measures of the diurnal BP profile, as well as the parameters characterizing arterial stiffness and central aortic pressure (CAP) were estimated. RESULTS After 8 weeks of therapy, target BP levels were recorded in 63 (76.8%) patients. After 24 weeks of treatment, the hypertensive patients with DD showed significant positive changes in all the investigated 24-hour BPM parameters and normalization of the diurnal BP profile in 65.1% of cases. During the treatment, there were significant decreases in pulse wave velocity, brachial arterial and aortic augmentation indices, aortic systolic and diastolic pressures, and mean aortic BP and an increase in the velocity of the reflected wave. CONCLUSION Triple therapy, including perindopril, indapamide SR, and amlodipine, contributed to the achievement of target BP levels in the majority of hypertensive patients with DD, with significant positive changes in all 24-hour BPM parameters, optimization of the diurnal BP profile in most patients, clinically significant improvement of the parameters that characterize arterial stiffness and CAP.
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Affiliation(s)
- V V Skibitsky
- Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia
| | - A V Fendrikova
- Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia
| | - A V Skibitsky
- Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia
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van Agtmaal MJM, Houben AJHM, Pouwer F, Stehouwer CDA, Schram MT. Association of Microvascular Dysfunction With Late-Life Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:729-739. [PMID: 28564681 PMCID: PMC5710252 DOI: 10.1001/jamapsychiatry.2017.0984] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/26/2017] [Indexed: 12/14/2022]
Abstract
Importance The etiologic factors of late-life depression are still poorly understood. Recent evidence suggests that microvascular dysfunction is associated with depression, which may have implications for prevention and treatment. However, this association has not been systematically reviewed. Objective To examine the associations of peripheral and cerebral microvascular dysfunction with late-life depression. Data Sources A systematic literature search was conducted in MEDLINE and EMBASE for and longitudinal studies published since inception to October 16, 2016, that assessed the associations between microvascular dysfunction and depression. Study Selection Three independent researchers performed the study selection based on consensus. Inclusion criteria were a study population 40 years of age or older, a validated method of detecting depression, and validated measures of microvascular function. Data Extraction and Synthesis This systematic review and meta-analysis has been registered at PROSPERO (CRD42016049158) and is reported in accordance with the PRISMA and MOOSE guidelines. Data extraction was performed by an independent researcher. Main Outcomes and Measures The following 5 estimates of microvascular dysfunction were considered in participants with or without depression: plasma markers of endothelial function, albuminuria, measurements of skin and muscle microcirculation, retinal arteriolar and venular diameter, and markers for cerebral small vessel disease. Data are reported as pooled odds ratios (ORs) by use of the generic inverse variance method with the use of random-effects models. Results A total of 712 studies were identified; 48 were included in the meta-analysis, of which 8 described longitudinal data. Data from 43 600 participants, 9203 individuals with depression, and 72 441 person-years (mean follow-up, 3.7 years) were available. Higher levels of plasma endothelial biomarkers (soluble intercellular adhesion molecule-1: OR, 1.58; 95% CI, 1.28-1.96), white matter hyperintensities (OR, 1.29; 95% CI, 1.19-1.39), cerebral microbleeds (OR, 1.18; 95% CI, 1.03-1.34), and cerebral (micro)infarctions (OR, 1.30; 95% CI, 1.21-1.39) were associated with depression. Among the studies available, no significant associations of albuminuria and retinal vessel diameters with depression were reported. Longitudinal data showed a significant association of white matter hyperintensities with incident depression (OR, 1.19; 95% CI, 1.09-1.30). Conclusions and Relevance This meta-analysis shows that both the peripheral and cerebral forms of microvascular dysfunction are associated with higher odds of (incident) late-life depression. This finding may have clinical implications because microvascular dysfunction might provide a potential target for the prevention and treatment of depression.
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Affiliation(s)
- Marnix J. M. van Agtmaal
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
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van Sloten T. Vascular dysfunction: At the heart of cardiovascular disease, cognitive impairment and depressive symptoms☆. Artery Res 2017. [DOI: 10.1016/j.artres.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Shima H, Mori T, Ooi M, Sonoda M, Shoji T, Ishimura E, Okamura M, Ishizaka N, Inaba M. Silent Cerebral Microbleeds and Longitudinal Risk of Renal and Cardiovascular Events in Patients with CKD. Clin J Am Soc Nephrol 2016; 11:1557-1565. [PMID: 27354659 PMCID: PMC5012493 DOI: 10.2215/cjn.13481215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the general population, the presence of cerebral microbleeds on T2*-weighted magnetic resonance imaging has been reported to be a predictor of future stroke. Patients with CKD have a high prevalence of microbleeds and are at higher risk of ESRD as well as cardiovascular disease, including stroke. Because endothelial dysfunction is the common pathophysiology among microbleeds, CKD, and cardiovascular disease, we hypothesized that the presence of microbleeds would be an important predictor of composite outcome, including both cardiovascular disease and renal events, in those with CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS This was a prospective cohort study of 404 patients with CKD who underwent T2*-weighted magnetic resonance imaging for this study between January of 2008 and January of 2011. The primary outcome was composite of cardiovascular and renal outcomes. Cardiovascular outcomes included cardiovascular death, the new onset of myocardial infarction, coronary revascularization, stroke, and amputation/revascularization because of peripheral artery disease. Renal outcomes included doubling of the serum creatinine level and development of ESRD requiring dialysis or transplantation. RESULTS At baseline, microbleeds were present in 83 (20.5%) patients. During the follow-up median period of 2.3 years, 124 of the 404 patients experienced the composite outcome. The presence of microbleeds was associated with higher risk for the composite outcome in an unadjusted Cox model, and it remained significant after adjustment for age, sex, diabetes, and systolic BP (hazard ratio [HR], 2.58; 95% confidence interval [95% CI], 1.68 to 3.46 for composite outcome; hazard ratio, 2.41; 95% CI, 1.55 to 3.77 for renal outcome; hazard ratio, 3.46; 95% CI, 1.62 to 7.43 for cardiovascular disease outcome). CONCLUSIONS In patients with CKD, the presence of microbleeds is a novel and independent predictor of both renal and cardiovascular disease end points.
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Affiliation(s)
- Hideaki Shima
- Division of Nephrology, Department of Internal Medicine and
| | - Tatsuhiko Mori
- Division of Nephrology, Department of Internal Medicine and
| | - Masayuki Ooi
- Division of Nephrology, Department of Internal Medicine and
| | - Mika Sonoda
- Departments of Endocrinology, Metabolism and Molecular Medicine
| | | | - Eiji Ishimura
- Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan; and
| | - Mikio Okamura
- Division of Nephrology, Ohno Memorial Hospital, Osaka, Japan
| | - Nobukazu Ishizaka
- Division of Cardiology, Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masaaki Inaba
- Departments of Endocrinology, Metabolism and Molecular Medicine
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van Sloten TT, Stehouwer CDA. Carotid Stiffness: A Novel Cerebrovascular Disease Risk Factor. Pulse (Basel) 2016; 4:24-7. [PMID: 27493900 DOI: 10.1159/000445354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Carotid stiffening is considered an important element in the pathogenesis of cerebrovascular diseases. These include stroke as well as vascular dementia and depression. However, results of individual studies evaluating the association between carotid stiffening and incident stroke have been inconsistent. Therefore, we have conducted a systematic review and meta-analysis, showing that carotid stiffening is associated with incident stroke independently of cardiovascular risk factors and aortic stiffness. In addition, carotid stiffening improved stroke risk prediction beyond the Framingham stroke risk factors and aortic stiffness. Other studies have shown that carotid stiffening is associated with a higher incidence of vascular dementia and depressive symptoms. This suggests that carotid stiffness is a potential separate target for prevention strategies of cerebrovascular disease.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine and the Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and the Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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