title: Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study.
abstract: OBJECTIVE
  Depression has been associated with inflammation in patients with coronary heart disease. However, it is uncertain whether depressive symptoms lead to inflammation or vice versa.
  
  
  METHODS
  The authors evaluated 667 outpatients with established coronary heart disease from the Heart and Soul Study. Depressive symptoms were assessed annually with the 9-item Patient Health Questionnaire. Participants were categorized as having no significant depressive symptoms (score below 10 at all interviews), depressive symptoms (score of 10 or higher) at one interview, or depressive symptoms at two or more interviews. At baseline and 5-year follow-up, fasting blood samples were collected to measure three inflammatory biomarkers: fibrinogen, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP).
  
  
  RESULTS
  Of the 667 participants, 443 had no depressive symptoms, 86 had depressive symptoms at one assessment, and 138 had depressive symptoms at two or more annual assessments. Across the three groups, greater depressive symptoms were associated with higher subsequent log-transformed levels of IL-6 and hsCRP, and the association with higher fibrinogen levels approached significance. Baseline inflammation did not predict subsequent depressive symptoms. The association of depressive symptoms with subsequent inflammation levels was eliminated after adjustment for health behaviors associated with depression-physical inactivity, smoking, and higher body mass index.
  
  
  CONCLUSIONS
  Depressive symptoms predicted higher IL-6 and hsCRP levels among outpatients with coronary heart disease, but higher inflammation levels did not predict subsequent depressive symptoms. The association between depressive symptoms and inflammation was no longer significant after adjustment for health behaviors, which suggests these behaviors may mediate depressive effects.
authors: Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands. h.e.duivis@uvt.nl
authors: Hester E
authors: HE
authors: Duivis
authors: Peter
authors: P
authors: de Jonge
authors: Brenda W
authors: BW
authors: Penninx
authors: Bee Ya
authors: BY
authors: Na
authors: Beth E
authors: BE
authors: Cohen
authors: Mary A
authors: MA
authors: Whooley
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D003327:Coronary Disease / Q000276:immunology* / Q000523:psychology*; D003866:Depressive Disorder / Q000276:immunology* / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019222:Mind-Body Relations, Metaphysical; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D018836:Inflammation Mediators; D015850:Interleukin-6; D005340:Fibrinogen; D002097:C-Reactive Protein