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Depression severity is associated with increased inflammation in veterans with peripheral artery disease

Hernandez, Natalie V.M. ; Ramirez, Joel L. ; Khetani, Sukaynah A. ; Spaulding, Kimberly A. ; Gasper, Warren J. ; Hiramoto, Jade ; Lindqvist, Daniel LU ; Wolkowitz, Owen M. LU ; Hills, Nancy K. and Grenon, S. Marlene , et al. (2018) In Vascular Medicine (United Kingdom) 23(5). p.445-453
Abstract

The present study examines the association between depressive symptoms and inflammatory markers in peripheral artery disease (PAD) to better understand the mechanistic relationship between depression and PAD. A cross-sectional sample of 117 patients with PAD (97% male, 76% Caucasian) was recruited from the San Francisco Veterans Affairs Medical Center. Patients were categorized into three subgroups based upon current depressive symptom severity, as defined by Patient Health Questionnaire-8 scores: no symptoms (score of 0–4, n = 62), mild symptoms (score of 5–9, n = 33), and moderate/severe symptoms (score ≥ 10, n = 22). Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), soluble intercellular adhesion... (More)

The present study examines the association between depressive symptoms and inflammatory markers in peripheral artery disease (PAD) to better understand the mechanistic relationship between depression and PAD. A cross-sectional sample of 117 patients with PAD (97% male, 76% Caucasian) was recruited from the San Francisco Veterans Affairs Medical Center. Patients were categorized into three subgroups based upon current depressive symptom severity, as defined by Patient Health Questionnaire-8 scores: no symptoms (score of 0–4, n = 62), mild symptoms (score of 5–9, n = 33), and moderate/severe symptoms (score ≥ 10, n = 22). Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-alpha (TNF-α) were assayed and log-transformed for multivariable analysis. To decrease the possibility of Type 1 errors, inflammatory markers were standardized and summed to create a total inflammatory score. In a multivariable analysis controlling for demographics, PAD severity, and atherosclerotic risk factors, mild and moderate/severe depressive symptoms were predictive of a higher total inflammatory score when compared to the group with no symptoms (mild symptoms p = 0.04, moderate/severe symptoms p = 0.007). Exploratory multivariable analyses of individual inflammatory markers found IL-6 levels were significantly higher in the moderate/severe symptoms group (p = 0.006) than in the no symptoms group. Moreover, hs-CRP and ICAM-1 trended upwards with increasing depression severity. TNF-α was not associated with depression severity. We conclude that depressive symptom severity was independently associated with greater inflammation in PAD. Future research should examine the strength and directionality of this association through larger prospective cohort studies, as well as investigate the pathophysiological mechanisms responsible.

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publication status
published
subject
keywords
depression, inflammation, peripheral artery disease (PAD)
in
Vascular Medicine (United Kingdom)
volume
23
issue
5
pages
9 pages
publisher
SAGE Publications
external identifiers
  • pmid:30035700
  • scopus:85050553303
ISSN
1358-863X
DOI
10.1177/1358863X18787640
language
English
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yes
id
91bb49b8-9284-4878-b6f5-92c2bf2657e5
date added to LUP
2018-10-01 11:59:49
date last changed
2020-01-16 03:31:56
@article{91bb49b8-9284-4878-b6f5-92c2bf2657e5,
  abstract     = {<p>The present study examines the association between depressive symptoms and inflammatory markers in peripheral artery disease (PAD) to better understand the mechanistic relationship between depression and PAD. A cross-sectional sample of 117 patients with PAD (97% male, 76% Caucasian) was recruited from the San Francisco Veterans Affairs Medical Center. Patients were categorized into three subgroups based upon current depressive symptom severity, as defined by Patient Health Questionnaire-8 scores: no symptoms (score of 0–4, n = 62), mild symptoms (score of 5–9, n = 33), and moderate/severe symptoms (score ≥ 10, n = 22). Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-alpha (TNF-α) were assayed and log-transformed for multivariable analysis. To decrease the possibility of Type 1 errors, inflammatory markers were standardized and summed to create a total inflammatory score. In a multivariable analysis controlling for demographics, PAD severity, and atherosclerotic risk factors, mild and moderate/severe depressive symptoms were predictive of a higher total inflammatory score when compared to the group with no symptoms (mild symptoms p = 0.04, moderate/severe symptoms p = 0.007). Exploratory multivariable analyses of individual inflammatory markers found IL-6 levels were significantly higher in the moderate/severe symptoms group (p = 0.006) than in the no symptoms group. Moreover, hs-CRP and ICAM-1 trended upwards with increasing depression severity. TNF-α was not associated with depression severity. We conclude that depressive symptom severity was independently associated with greater inflammation in PAD. Future research should examine the strength and directionality of this association through larger prospective cohort studies, as well as investigate the pathophysiological mechanisms responsible.</p>},
  author       = {Hernandez, Natalie V.M. and Ramirez, Joel L. and Khetani, Sukaynah A. and Spaulding, Kimberly A. and Gasper, Warren J. and Hiramoto, Jade and Lindqvist, Daniel and Wolkowitz, Owen M. and Hills, Nancy K. and Grenon, S. Marlene and Zahner, Greg J.},
  issn         = {1358-863X},
  language     = {eng},
  month        = {10},
  number       = {5},
  pages        = {445--453},
  publisher    = {SAGE Publications},
  series       = {Vascular Medicine (United Kingdom)},
  title        = {Depression severity is associated with increased inflammation in veterans with peripheral artery disease},
  url          = {http://dx.doi.org/10.1177/1358863X18787640},
  doi          = {10.1177/1358863X18787640},
  volume       = {23},
  year         = {2018},
}