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Autonomic Nervous System Dysfunction and Inflammation Contribute to the Increased Cardiovascular Mortality Risk Associated With Depression

Year: 2010
Type: article
Abstract: OBJECTIVE: To investigate prospectively whether autonomic nervous system (ANS) dysfunction and inflammation play a role in the increased cardiovascular disease (CVD)-related mortality risk associated with depression. METHODS: Participants in the Cardiovascular Health Study (n = 907; mean age, 71.3 ± 4.6 years; 59.1% women) were evaluated for ANS indices derived from heart rate variability (HRV) analysis (frequency and time domain HRV, and nonlinear indices, including detrended fluctuation analysis (DFA(1)) and heart rate turbulence). Inflammation markers included C-reactive protein, interleukin-6, fibrinogen, and white blood cell count). Depressive symptoms were assessed, using the 10-item Centers for Epidemiological Studies Depression scale. Cox proportional hazards models were used to investigate the mortality risk associated with depression, ANS, and inflammation markers, adjusting for demographic and clinical covariates. RESULTS: Depression was associated with ANS dysfunction (DFA(1), p = .018), and increased inflammation markers (white blood cell count, p = .012, fibrinogen p = .043) adjusting for covariates. CVD-related mortality occurred in 121 participants during a median follow-up of 13.3 years. Depression was associated with an increased CVD mortality risk (hazard ratio, 1.88; 95% confidence interval, 1.23-2.86). Multivariable analyses showed that depression was an independent predictor of CVD mortality (hazard ratio, 1.72; 95% confidence interval, 1.05-2.83) when adjusting for independent HRV and inflammation predictors (DFA(1), heart rate turbulence, interleukin-6), attenuating the depression-CVD mortality association by 12.7% (p < .001). CONCLUSION: Autonomic dysfunction and inflammation contribute to the increased cardiovascular mortality risk associated with depression, but a large portion of the predictive value of depression remains unexplained by these neuroimmunological measures.
DOI: 10.1097/psy.0b013e3181eadd2b
Authors: Willem J. Kop, Phyllis K. Stein, Russell P. Tracy, Joshua I. Barzilay, Richard Schulz, John S. Gottdiener
Institutions: University of Vermont, University of Maryland, Baltimore, University of Maryland Medical Center, Emory University, University of Pittsburgh, Washington University in St. Louis, National Heart, Lung, and Blood Institute, National Institute of Neurological Disorders and Stroke
Language: English
Field: Medicine
Open Access status: green
Awards: G1023702118, G10717269, G1220223050, G125972088, CORONARY HEART DISEASE AND STROKE, CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84, CHS-ULTRASOUND READING, CORONARY HEART DISEASE AND STROKE, MRI READING CENTER FOR THE CARDIOVASCULAR HEALTH STUDY, CORONARY HEART DISEASE AND STROKE IN PEOPLE AGED 65-84, G1909643007, G2194386449, CORONARY HEART DISEASE AND STROKE IN PEOPLE AGED 65-84, CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84, CORONARY HEART DISEASE &STROKE IN THE ELDERLY, G270907595, G277826483, G2800149121, G2813236138, G328935669, BEHAVIORAL AND IMMUNOLOGICAL FACTORS IN CORONARY DISEASE, G34347772, CENTRAL BLOOD ANALYSIS LABORATORY FOR CHS, G4012114008, G4048755144, G423252844, G4660668308, G4987078009, G5167412771, HOLTER DERIVED DATA AND OUTCOME IN THE CHS, CHS Events Follow-up Study, G6226795708, CHS-Transition Phase, G687544517, G7286144250, CHS RETINAL READING CENTER, G764651519, CARDIOVASCULAR HEALTH STUDY--ECHOCARDIOGRAPHY, G766700449, G777822606, G7999488110, G806768229, G8593276544, G859984287, G905887895, G936067872, G960597250
OpenAlex ID: W2066581980
FWCI: 9.118
Cites: 71
Cited by: 198
Related to: 10