Mark D. Sullivan, M.D., Ph.D., from the University of Washington School of Medicine in Seattle, and colleagues investigated the impact of depression on cardiovascular disease outcomes in type 2 diabetes. Responses to the Patient Health Questionnaire (PHQ)-9 measure of depression symptoms were collected from 2,053 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.
The researchers found that, in fully adjusted models, depression was not significantly associated with the primary composite outcome of cardiovascular death, nonfatal heart attack, or stroke (hazard ratio [HR], 1.53; 95 percent confidence interval [CI], 0.85 to 2.73), or with the ACCORD microvascular composite outcome (HR, 0.93; 95 percent CI, 0.53 to 1.62). For participants with PHQ-identified probable major depression and for those with a PHQ score of ≥10, all-cause mortality was significantly increased (HR, 2.24 and 1.84, respectively). The effect of depression on all-cause mortality was independent of previous cardiovascular events or assignment to intensive or standard glycemia control. There was a borderline significant association between probable major depression and the ACCORD macrovascular end point (HR, 1.42; 95 percent CI, 0.99 to 2.04).
"Depression increases the risk of all-cause mortality and may increase the risk of macrovascular events among adults with type 2 diabetes at high risk for cardiovascular events," the authors write.
Published online before print May 22, 2012, doi: 10.2337/dc11-1791 Diabetes Care May 22, 2012