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Cardiac risk factors in patients with diabetes mellitus and major depression

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Abstract

OBJECTIVE: The prevalence of major depression is approximately 2-fold higher in patients with diabetes mellitus compared to medical controls. We explored the association of major depression with 8 cardiac risk factors in diabetic patients with and without evidence of cardiovascular disease (CVD).

DESIGN: A mail survey questionnaire was administered to a population-based sample of 4,225 patients with diabetes to obtain data on depression status, diabetes self-care (diet, exercise, and smoking), diabetes history, and demographics. On the basis of automated data we measured diabetes complications, glycosylated hemoglobin, medical comorbidity, low-density lipid levels, triglyceride levels, diagnosis of hypertension, and evidence of microalbuminuria. Separate analyses were conducted for subgroups according to the presence or absence of CVD.

SETTING: Nine primary care clinics of a nonprofit health maintenance organization.

MAIN RESULTS: Patients with major depression and diabetes were 1.5- to 2-fold more likely to have 3 or more cardiovascular risk factors as patients with diabetes without depression (62.5% vs 38.4% in those without CVD, and 61.3% vs 45% in those with CVD). Patients with diabetes without CVD who met criteria for major depression were significantly more likely to be smokers, to have a body mass index (BMI) ≥ 30 kg/m2, to lead a more sedentary lifestyle, and to have HbA1c levels of >8.0% compared to nondepressed patients with diabetes without heart disease. Patients with major depression, diabetes, and evidence of heart disease were significantly more likely to have a BMI ≥30 kg/m2, a more sedentary lifestyle, and triglyceride levels >400 mg/dl than nondepressed diabetic patients with evidence of heart disease.

CONCLUSIONS: Patients with major depression and diabetes with or without evidence of heart disease have a higher number of CVD risk factors. Interventions aimed at decreasing these risk factors may need to address treatment for major depression in order to be effective.

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Authors and Affiliations

  1. Center for Health Studies, Group Health Cooperative, Seattle, Wash.

    Elizabeth H. B. Lin MD, MPH, Michael Von Korff ScD, Greg Simon MD, MPH, Evette Ludman PhD & Terry Bush PhD

  2. Department of Medicine, Veterans Administrative Hospital, University of Washington, Seattle, Wash.

    Bessie Young MD, MPH

  3. Health Services, Research and Psychiatric Epidemiology, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific, Box 356560, 98195-6560, Seattle, WA

    Wayne J. Katon MD, Joan Russo PhD & Paul Ciechanowski MD, MPH

Authors
  1. Wayne J. Katon MD
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  2. Elizabeth H. B. Lin MD, MPH
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  3. Joan Russo PhD
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Correspondence to Wayne J. Katon MD.

Additional information

This work was supported by grants MH41739 and MH016473 from the National Institute of Mental Health Services Division, Bethesda, Md (Dr. Katon).

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Katon, W.J., Lin, E.H.B., Russo, J. et al. Cardiac risk factors in patients with diabetes mellitus and major depression. J GEN INTERN MED 19, 1192–1199 (2004). https://doi.org/10.1111/j.1525-1497.2004.30405.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30405.x

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