Carotid atherosclerosis is associated with late-onset depressive disorders

  • Ms Adrie Seldenrijk, VU University Medical Center, Amsterdam, The Netherlands
  • Dr Hein van Hout, VU University Medical Center, Amsterdam, The Netherlands
  • Dr Harm van Marwijk, VU University Medical Center, Amsterdam, The Netherlands
  • Dr Eric de Groot, Academic Medical Center, University of Amsterdam, The Netherlands
  • Mr Johan Gort, Academic Medical Center, University of Amsterdam, The Netherlands
  • Dr Cees Rustemeijer, Amstelland Hospital, Amstelveen, The Netherlands
  • Prof Michaela Diamant, VU University Medical Center, Amsterdam, The Netherlands
  • Prof Brenda Penninx, VU University Medical Center, Amsterdam, The Netherlands

Objective: Psychopathology and cardiovascular disease have been associated, whereas the temporal course and the underlying mechanisms are still unclear. This study examined the presence of (subclinical) atherosclerotic disease in persons with depressive or anxiety disorder, also taking into account specific disorder characteristics (severity, duration, recurrence, age of onset).

Methods: Participants were 470 persons with DSM-IV based diagnoses of depressive and/or anxiety disorders and 179 controls, aged 46.4 (range 20-66) years, 65.3% female, enrolled in the Netherlands Study of Depression and Anxiety (NESDA). Carotid intima-media thickness (CIMT) and plaque were used as markers of atherosclerosis, obtained by B-mode ultrasound imaging.

Results: Overall, depressive and anxiety disorders were not associated with CIMT and plaque presence. However, age of onset of depressive disorder was strongly associated with CIMT (0.01mm per 10 yrs, p=.008) and plaque presence (OR=1.35 per 10 yrs, 95%CI=1.02-1.79, p=.04). As compared to controls, early-onset (<40 yrs) depressed tended to have a lower CIMT but no different plaque risk, whereas those with late-onset (≥40 yrs) had an increased CIMT (at least in the carotid bifurcation) and tended to have a 1.78 fold increased plaque risk. Depressed cases with a single episode also had a more than two-fold increased plaque risk than both recurrently depressed and controls.

Conclusions: These results show that carotid atherosclerosis is more prevalent in late-onset depressive disorders. This finding expands the evidence that late-onset as compared to early-onset depression has a distinct pathophysiology, involving a vascular component with increased cardiovascular risk.