Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis
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Importance: Previous research has linked a history of depression with arterial stiffness (AS) during midlife. Objective: To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS). Design, Settings, and Participants: This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019. Exposures: Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference. Main Outcomes and Measures: Peripherally assessed AS index (ASI) using digital photoplethysmography. Results: Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association was for waist circumference, accounting for 25% of the association between depression and ASI levels (direct association: β = 0.26; 95% CI, 0.18-0.34; indirect association: β = 0.09; 95% CI, 0.06-0.11). Among men, hypertriglyceridemia accounted for 19% of the association between depression and ASI (direct association: β = 0.22; 95% CI, 0.05-0.40; indirect association: β = 0.05; 95% CI, 0.02-0.08). Conclusions and Relevance: One-third of the association of depression with elevated ASI levels during midlife may be accounted for by combined MetS and inflammatory processes. Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.
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The findings might be explained by period factors, such as the possible higher impact on the group aged 45 to 59 of the previous economic recession, and other potential mediators in the relationship of age and depression, such as inflammation increasing with age or family and social roles.
“Moreover, these findings might be explained by a number of reasons, such as period factors (e.g. the possible higher impact on group aged 45 to 59 of the previous economic recession period, particularly in those belonging to the most disadvantaged groups) and other potential mediators in the relationship of age and depression”
From Prevalence and age patterns of depression in the United Kingdom. A population-based study (2021) · cites this paper as Dregan et al., 2020
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- Alberti KG, Eckel RH, Grundy SM, et al. ; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of OPEN 1/29/2021 Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990710/?report=printable 12/23
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Prevalence and age patterns of depression in the United Kingdom. A population-based study
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Self-citation
- Authors
- Dregan, A., Rayner, L., Davis, K. A. S., Bakolis, I., Arias de la Torre, J., Das-Munshi, J., Hatch, S. L., Stewart, R., & Hotopf, M.
- Affiliations
- King's College London (GB)
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- Corresponding author
- Dregan, Alex
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2020-06-01
- Volume
- 77
- Issue
- 6
- Pages
- 598
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6990710
- OpenAlex
- W3004079077
- Cited by
- 132
- References
- 63
- Citations by year
- 2026: 10 · 2025: 29 · 2024: 36 · 2023: 28 · 2022: 15 · 2021: 10 · 2020: 4
- FWCI
- 8.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- JAMA Psychiatry (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- GlaxoSmithKline
- South London and Maudsley NHS Foundation Trust
- Wellcome Trust
- European Federation of Pharmaceutical Industries and Associations
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research (NF-SI-0515-10102, NF-SI-0617-10125)
- Department of Health and Social Care
- Guy's and St Thomas' Charity
- Academy of Medical Sciences (AMS-CSF4-Das-Munshi)
- King's College London
- Medical Research Council (MR/T045302/1, MR/S028188/1, MC_PC_17228, MC_PC_12028, MC_PC_17214)
- Engineering and Physical Sciences Research Council (EP/N027280/1)
- Economic and Social Research Council (ES/S012567/1)
- Janssen Pharmaceuticals
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Keywords
- depression, arterial stiffness, metabolic syndrome, mediation analysis, C-reactive protein, waist circumference, hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, middle-aged adults, cardiovascular risk, UK Biobank, photoplethysmography, inflammation, lifestyle risk factors, sex differences
- MeSH terms
- Mediation Analysis, Adult, Aged, Depression, Female, Humans, Inflammation, Male, Middle Aged, Retrospective Studies, Biological Specimen Banks, Metabolic Syndrome, Vascular Stiffness
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