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Geraets AF, van Agtmaal MJ, Stehouwer CD, Sörensen BM, Berendschot TT, Webers CA, Schaper NC, Henry RM, van der Kallen CJ, Eussen SJ, Koster A, van Sloten TT, Köhler S, Schram MT, Houben AJ. Association of Markers of Microvascular Dysfunction With Prevalent and Incident Depressive Symptoms. Hypertension 2020; 76:342-349. [DOI: 10.1161/hypertensionaha.120.15260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The etiology of late-life depression (LLD) is still poorly understood. Microvascular dysfunction (MVD) has been suggested to play a role in the etiology of LLD, but direct evidence of this association is scarce. The aim of this study was to investigate whether direct and indirect markers of early microvascular dysfunction are associated with prevalent and incident LLD in the population-based Maastricht Study cohort. We measured microvascular dysfunction at baseline by use of flicker light-induced retinal vessel dilation response (Dynamic Vessel Analyzer), heat-induced skin hyperemic response (laser- Doppler flowmetry), and plasma markers of endothelial dysfunction (endothelial dysfunction; sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [Von Willebrand Factor]). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) at baseline and annually over 4 years of follow-up (n=3029; mean age 59.6±8.2 years, 49.5% were women, n=132 and n=251 with prevalent and incident depressive symptoms [PHQ-9≥10]). We used logistic, negative binominal and Cox regression analyses, and adjusted for demographic, cardiovascular, and lifestyle factors. Retinal venular dilatation and plasma markers of endothelial dysfunction were associated with the more prevalent depressive symptoms after full adjustment (PHQ-9 score, RR, 1.05 [1.00–1.11] and RR 1.06 [1.01–1.11], respectively). Retinal venular dilatation was also associated with prevalent depressive symptoms (PHQ-9≥10; odds ratio, 1.42 [1.09–1.84]), after full adjustment. Retinal arteriolar dilatation and plasma markers of endothelial dysfunction were associated with incident depressive symptoms (PHQ-9≥10; HR, 1.23 [1.04–1.46] and HR, 1.19 [1.05–1.35]), after full adjustment. These findings support the concept that microvascular dysfunction in the retina, and plasma markers of endothelial dysfunction is involved in the etiology of LLD and might help in finding additional targets for the prevention and treatment of LLD.
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Affiliation(s)
- Anouk F.J. Geraets
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Marnix J.M. van Agtmaal
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Ben M. Sörensen
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Tos T.J.M. Berendschot
- Department of Ophthalmology (T.T.J.M.B., C.A.B.W.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Carroll A.B. Webers
- Department of Ophthalmology (T.T.J.M.B., C.A.B.W.), Maastricht University Medical Center (MUMC+), the Netherlands
| | - Nicolaas C. Schaper
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Ronald M.A. Henry
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Simone J.P.M. Eussen
- Department of Epidemiology (S.J.P.M.E.), Maastricht University Medical Center (MUMC+), the Netherlands
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences (S.J.P.M.E., A.K.), Maastricht University, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine (A.K.), Maastricht University Medical Center (MUMC+), the Netherlands
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences (S.J.P.M.E., A.K.), Maastricht University, the Netherlands
| | - Thomas T. van Sloten
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
| | - Miranda T. Schram
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Alfons J.H.M. Houben
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
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