Depression, Diabetes Raise CV Mortality Risk in Women

Article excerpt

The combination of type 2 diabetes and depression doubled the overall risk of death and nearly tripled the likelihood of dying of cardiovascular disease within 6 years, an analysis of data on 78,282 women found.

Previous studies have shown an association between depression or diabetes and increased risk of death from any cause or from cardiovascular disease, but the combined effects of these diseases on mortality have not been well studied, especially in women. Earlier studies also tended to be smaller and to have shorter follow-up.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and his associates analyzed data on participants in the prospective Nurses' Health Study who were 54-79 years of age in 2000 and who were followed until 2006. There were 979 deaths from cardiovascular disease and 4,654 deaths from any cause during that time.

Compared with the 80% of women who developed neither diabetes nor depression, the age-adjusted relative risk of death was 1.71 in the 5% of women with diabetes alone, 1.76 in the 14% of women with depression alone, and 3.11 in the 1% of women with both diseases. The relative risk of death from cardiovascular disease was 1.67 in women with diabetes alone, 1.37 in women with depression alone, and 2.72 in those with both diabetes and depression (Arch. Gen. Psychiatry 2011;68:42-50).

The increased risks with either diabetes or depression were statistically significant, and the higher risks with both diseases were significant compared with either disease alone, even after adjustment for the effects of age, family history of diabetes and cancer, history of myocardial infarction, current marital status, ethnicity, body mass index, alcohol consumption, smoking status, current multivitamin use, estrogen hormone use, current aspirin use, and major comorbidities including hypertension, hypercholesterolemia, heart disease, stroke, and cancer.

The highest risks were seen in women with depression combined with more severe diabetes, indicated by a longer duration of diabetes or treatment with oral medication or insulin.

Death from cardiovascular disease was three times more likely in depressed women who had had diabetes for more than 10 years, and four times more likely in depressed women who received insulin therapy for diabetes, compared with women who had neither depression nor diabetes. …