title: Anxiety and depressive symptoms are associated with higher carotid intima-media thickness. Cross-sectional analysis from ELSA-Brasil baseline data.
abstract: BACKGROUND
  Studies focusing on the association between anxiety/depressive symptoms and accelerated subclinical atherosclerosis have yielded mixed results. Our aim is to examine associations between anxiety/depressive symptoms, common mental disorder (CMD), major depression disorder (MDD) or generalized anxiety disorder (GAD) and carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline.
  
  
  METHODS
  The ELSA-Brasil baseline assessment included CIMT measurements and the Clinical Interview Schedule - Revised (CIS-R), a validated questionnaire for anxiety/depressive symptoms/diagnoses. We analyzed participants without previous coronary heart disease or stroke, and with high-quality CIMT images. We built regression models to determine whether the CIS-R score, CMD, MDD or GAD were associated with maximal CIMT levels.
  
  
  RESULTS
  The study sample comprised 9744 participants. We found that individuals with higher CIS-R scores (Odds ratio for one standard deviation increase [OR]:1.12; 95% confidence interval [95%CI]:1.06-1.19), CMD (OR:1.22; 95%CI:1.07-1.38) and GAD (OR:1.19; 95%CI:1.01-1.41) had significantly higher odds of being classified in the highest age, sex and race-specific CIMT quartile. In the linear models, after adjustment for traditional cardiovascular risk factors, higher CIS-R scores (β:0.005; P = 0.010) and GAD (β:0.010; P = 0.049) were independently associated with CIMT values.
  
  
  CONCLUSIONS
  Individuals with more symptoms of anxiety and/or depression, or diagnoses of CMD or GAD, had higher CIMT values, compared to peers of same age, sex and race. CIS-R scores and GAD were independently associated with higher CIMT values. These results suggest an association between anxiety/depressive symptoms (and, most notably, GAD) and accelerated subclinical atherosclerosis.
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, Brazil. Electronic address: itamarss@usp.br.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil.
authors.forename: André R
authors.initials: AR
authors.lastname: Brunoni
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil; School of Psychology and Discipline of Psychiatry, University of Sydney, Griffith Taylor Building (A19), Sydney, NSW 2006, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kemp
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, Avenida Prof. Lineu Prestes, 2565, Cidade Universitária, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D058070:Asymptomatic Diseases; D001938:Brazil / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Anxiety; Atherosclerosis; Common mental disorder; Depression; Generalized anxiety disorder; Intima-media thickness