Association of cardiovascular risk factors and disease with depression in later life

Objective: The objective of this study is to determine the association between established cardiovascular risk factors and depression among older men. Methods: The authors conducted a cross-sectional study of a community-representative sample of 5,439 men aged 71 - 89 years. Cardiovascular disease and risk factors assessed included history of diabetes, hypertension, angina, myocardial infarction, and stroke; current smoking; total cholesterol and fractions; triglycerides; total plasma homocysteine; and MTHFR677 genotype. Depression was defined by a Geriatric Depression Scale 15 items score of 7 or greater. Results: A complete data set was available for 4,204 men, of whom 212 were depressed (5%). Men who were depressed reported higher frequency of diabetes (23.1% versus 13.2%), angina (30.2% versus 20.4%), myocardial infarction (26.2% versus 16.0%), and stroke (23.6% versus 9.1%) than nondepressed men. Participants with depression were also more likely to have plasma homocysteine above 15 mu mol/L (39.1% versus 25.5%) and high triglycerides (32.1% versus 20.9%) than nondepressed subjects. Depressed older men were also more likely to be active smokers (9.9% versus 4.8%). The other factors measured in the study were not significantly associated with depression. Estimation of the population-attributable fraction (PAF) after logistic regression showed that high plasma homocysteine had the highest PAF for depression ( PAF: 15%, 95% confidence interval [ 95% CI]: 5% - 23%) followed by high triglycerides ( PAF: 11%, 95% CI: 2% - 18%), angina ( PAF: 9%, 95% CI: 2% - 15%), stroke ( PAF: 8%, 95% CI: 3% - 13%), diabetes ( PAF: 7%, 95% CI: 1% - 13%), myocardial infarction ( PAF: 5%, 95% CI: 0% - 11%), and smoking ( PAF: 5%, 95% CI: 1% - 9%). Conclusions: High plasma homocysteine and triglycerides appear to account for a considerable proportion of cases of depression in older men. The successful management of these risk factors may contribute to decrease the prevalence of depression in later life.