title: Depression, the metabolic syndrome and cardiovascular risk.
abstract: BACKGROUND
  The relationship between depression and the metabolic syndrome is unclear, and whether metabolic syndrome explains the association between depression and cardiovascular disease (CVD) risk is unknown.
  
  
  METHODS
  We studied 652 women who received coronary angiography as part of the Women's Ischemia Syndrome Evaluation (WISE) study and completed the Beck Depression Inventory (BDI). Women who had both elevated depressive symptoms (BDI > or =10) and a previous diagnosis of depression were considered at highest risk, whereas those with one of the two conditions represented an intermediate group. The metabolic syndrome was defined according to the ATP-III criteria. The main outcome was incidence of adverse CVD events (hospitalizations for myocardial infarction, stroke, congestive heart failure, and CVD-related mortality) over a median follow-up of 5.9 years.
  
  
  RESULTS
  After adjusting for demographic factors, lifestyle and functional status, both depression categories were associated with about 60% increased odds for metabolic syndrome compared with no depression (p = .03). The number of metabolic syndrome risk factors increased gradually across the three depression categories (p = .003). During follow-up, 104 women (15.9%) experienced CVD events. In multivariable analysis, women with both elevated symptoms and a previous diagnosis of depression had 2.6 times higher risk of CVD. When metabolic syndrome was added to the model, the risk associated with depression only decreased by 7%, and both depression and metabolic syndrome remained significant predictors of CVD.
  
  
  CONCLUSIONS
  In women with suspected coronary artery disease, the metabolic syndrome is independently associated with depression but explains only a small portion of the association between depression and incident CVD.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1256 Briarcliff Road NE, Suite-1 North, Atlanta, GA 30306, USA. viola.vaccarino@emory.edu
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Candace
authors.initials: C
authors.lastname: McClure
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: David S
authors.initials: DS
authors.lastname: Krantz
authors.forename: Susmita
authors.initials: S
authors.lastname: Parashar
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008019:Life Style; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors