Association between a serotonin transporter gene variant and hopelessness among men in the Heart and Soul Study.
BACKGROUND
Hopelessness is associated with mortality in patients with cardiac disease even after accounting for severity of depression. We sought to determine whether a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) is associated with increased hopelessness, and whether this effect is modified by sex, age, antidepressant use or depression in patients with coronary heart disease.


METHODS
We conducted a cross-sectional study of 870 patients with stable coronary heart disease. Our primary outcomes were hopelessness score (range 0-8) and hopeless category (low, moderate and high) as measured by the Everson hopelessness scale. Analysis of covariance and ordinal logistic regression were used to examine the independent association of genotype with hopelessness.


RESULTS
Compared to patients with l/l genotype, adjusted odds of a higher hopeless category increased by 35% for the l/s genotype and 80% for s/s genotype (p-value for trend = 0.004). Analysis of covariance demonstrated that the effect of 5-HTTLPR genotype on hopelessness was modified by sex (.04), but not by racial group (p = 0.63). Among men, odds of higher hopeless category increased by 40% for the l/s genotype and by 2.3-fold for s/s genotype (p-value p < 0.001), compared to no effect in the smaller female sample (p = 0.42). Results stratified by race demonstrated a similar dose-response effect of the s allele on hopelessness across racial groups.


CONCLUSIONS
We found that the 5-HTTLPR is independently associated with hopelessness among men with cardiovascular disease.
Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. kkangelaris@medicine.ucsf.edu
Kirsten Neudoerffer
KN
Kangelaris
Eric
E
Vittinghoff
Christian
C
Otte
Beeya
B
Na
Andrew D
AD
Auerbach
Mary A
MA
Whooley
D000368:Aged; D000483:Alleles; D015331:Cohort Studies; D003327:Coronary Disease / Q000235:genetics* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000235:genetics* / Q000523:psychology; D005260:Female; D056726:Genetic Association Studies / Q000379:methods; D014644:Genetic Variation / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic / Q000235:genetics; D011446:Prospective Studies; D050486:Serotonin Plasma Membrane Transport Proteins / Q000235:genetics*; D012727:Sex Characteristics
C493230:SLC6A4 protein, human; D050486:Serotonin Plasma Membrane Transport Proteins