Cardiac risk factors in patients with diabetes mellitus and major depression.
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).


METHODS
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.


METHODS
Nine primary care clinics of a nonprofit health maintenance organization.


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) > or = 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 > or = 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.
Katon
Wayne J
WJ
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195-6560, USA. wkaton@u.washington.edu
Lin
Elizabeth H B
EH
Russo
Joan
J
Von Korff
Michael
M
Ciechanowski
Paul
P
Simon
Greg
G
Ludman
Evette
E
Bush
Terry
T
Young
Bessie
B
D000419:Albuminuria / Q000150:complications; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D008078:Cholesterol, LDL / Q000097:blood; D003865:Major Depressive Disorder / Q000150:complications*; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides