Relationship between atherosclerosis and late-life depression: the Rotterdam Study.
BACKGROUND
Depression in late life has been associated with vascular abnormalities. Several studies have demonstrated that persons with brain infarcts are more likely to have depressive disorders. Furthermore, depression is related to the subsequent development of ischemic heart disease.


OBJECTIVE
To investigate the relationship between atherosclerosis at different locations and depression in the general population.


METHODS
Cross-sectional population-based study.


METHODS
The Rotterdam Study, a population-based cohort study.


METHODS
In 4019 men and women 60 years and older, we assessed atherosclerosis at different locations, including common carotid intima-media thickness, plaques in the carotid arteries, the ankle-brachial blood pressure index, and aortic atherosclerosis. An overall measure of extracoronary atherosclerosis was obtained in 3747 persons by computing the principal component of these extracoronary atherosclerosis measures. In a subgroup of 1986 persons, we additionally measured coronary calcifications.


METHODS
All subjects were screened for depressive symptoms. Screen-positive subjects had a psychiatric interview to diagnose depressive disorder.


RESULTS
More severe extracoronary atherosclerosis was associated with a higher prevalence of depressive disorders. For every 1-standard deviation increase, the prevalence increased by 30%. Furthermore, we found a strong relationship of severe coronary and aortic calcifications with depressive disorders (odds ratio, 3.89; 95% confidence interval, 1.55-9.77; and odds ratio, 2.00; 95% confidence interval, 1.02-3.96, respectively).


CONCLUSIONS
Atherosclerosis and depression are associated in the elderly. This finding is compatible with the vascular depression hypothesis. However, the cross-sectional nature of the study does not allow causal inferences. In particular, earlier depressive episodes may have contributed to the development of atherosclerosis.
Tiemeier
Henning
H
Departments of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
van Dijck
Wim
W
Hofman
Albert
A
Witteman
Jacqueline C M
JC
Stijnen
Theo
T
Breteler
Monique M B
MM
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors