Association between depressive symptoms and fibrosis markers: the Cardiovascular Health Study.
OBJECTIVE
Fibrosis plays an important role in heart failure (HF) and other diseases that occur more frequently with increasing age. Depression is associated with an increased risk of heart failure and other age-related diseases. This study examined the association between depressive symptoms and fibrosis markers in adults aged 65 years and above.


METHODS
Fibrosis markers and depressive symptoms were assessed in 870 participants (age=80.9+/-5.9 yrs, 49% women) using a case-control design based on heart failure status (307 HF patients and 563 age- and sex-matched controls, of whom 284 with CVD risk factors (hypertension, diabetes mellitus, or hypercholesterolemia) and 279 controls without these CVD risk factors). Fibrosis markers were procollagen type I (PIP), type I collagen (CITP), and procollagen type III (PIIINP). Inflammation markers included C-reactive protein, white blood cell counts and fibrinogen. Depression was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale using a previously validated cut-off point for depression (CES-D > or = 8). Covariates included demographic and clinical variables.


RESULTS
Depression was associated with higher levels of PIP (median=411.0, inter-quartile range (IQR)=324.4-472.7 ng/mL vs. 387.6, IQR=342.0-512.5 ng/mL, p=0.006) and CITP (4.99, IQR=3.53-6.85 vs. 4.53, IQR=3.26-6.22 microg/L, p=0.024), but not PIIIINP (4.07, IQR=2.75-5.54 microg/L vs. 3.58, IQR=2.71-5.01 microg/L, p=0.29) compared to individuals without depression. Inflammation markers were also elevated in depressed participants (CRP, p=0.014; WBC, p=0.075; fibrinogen, p=0.074), but these inflammation markers did not account for the relationship between depression and fibrosis markers.


CONCLUSIONS
Depression is associated with elevated fibrosis markers and may therefore adversely affect heart failure and other age-related diseases in which extra-cellular matrix formation plays a pathophysiological role.
Department of Medicine, University of Maryland, Baltimore, MD 21201, United States. wkop@medicine.umaryland.edu
Willem J
WJ
Kop
Emily A
EA
Kuhl
Eddy
E
Barasch
Nancy S
NS
Jenny
Stephen S
SS
Gottlieb
John S
JS
Gottdiener
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology*; D024042:Collagen Type I / Q000097:blood; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D004562:Electrocardiography; D004719:Endomyocardial Fibrosis / Q000453:epidemiology / Q000523:psychology; D005221:Fatigue / Q000523:psychology; D005260:Female; D005355:Fibrosis / Q000453:epidemiology / Q000523:psychology*; D006306:Health Surveys; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors
D015415:Biomarkers; D024042:Collagen Type I; D018836:Inflammation Mediators; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D002097:C-Reactive Protein