Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors

• Published in: Atherosclerosis Vol. 212; no. 1; pp. 292 - 298
• Main Authors: Pizzi, Carmine, Manzoli, Lamberto, Mancini, Stefano, Bedetti, Gigliola, Fontana, Fiorella, Costa, Grazia Maria
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.09.2010; Elsevier
• Subjects: Aged; Arteriosclerosis; Asymptomatic Diseases; Atherosclerosis (general aspects, experimental research); Autonomic nervous system; Autonomic Nervous System - physiopathology; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; C-Reactive Protein - analysis; Cardiology. Vascular system; Cardiovascular; Carotid Arteries - diagnostic imaging; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - physiopathology; Coronary Disease - etiology; Coronary Disease - immunology; Coronary Disease - physiopathology; Coronary heart disease; Coronary risk factors; Cross-Sectional Studies; Depression; Depression - complications; Depression - physiopathology; Electrocardiography, Ambulatory; Female; Heart; Heart Rate; Humans; Inflammation; Inflammation - complications; Inflammation - immunology; Inflammation - physiopathology; Inflammation Mediators - blood; Interleukin-6 - blood; Intima-media thickness; Italy; Linear Models; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Psychiatric Status Rating Scales; Risk Assessment; Risk Factors; Ultrasonography, Doppler; Intima-media thickness; Depression; Inflammation; Coronary risk factors; Autonomic nervous system; Mood disorder; Human; Cardiovascular disease; Asymptomatic; Artery; Vascular disease; Blood vessel; Carotid; Atherosclerosis; Risk factor; Circulatory system
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2010.04.038

We investigated the relationship between intima-media thickening (IMT) as an expression of preclinical atherosclerosis and coronary risk factors, including the autonomic nervous system and inflammation markers, in depressed subjects free from coronary artery disease. We studied 391 asymptomatic subjects with a cluster of risk factors, and we evaluated depression using the Beck Depression Inventory. IMT of the common carotid artery was determined by B-mode ultrasound imaging. Traditional risk factors for atherosclerosis were recorded. Markers of inflammation (C-reactive protein, CRP; interleukin 6, IL-6) and heart rate variability (time domain) were determined. A total of 90 (23.0%) subjects showed a depressive symptomatology. The average IMT was increased in depressed subjects (0.87±0.35mm) at risk for CHD but free from disease as compared to controls (0.77±0.19mm; p<0.001). Heart rate variability was reduced in depressed subjects. Levels of SDNN (103±14ms) and SDANN (93±20ms) were decreased in depressed subjects as compared to non-depressed subjects (SDNN 113±22ms and SDANN 108±35ms; p<0.001). Subjects with depression had higher CRP (1.14±0.65mg/dl) and IL-6 (2.00±0.40pg/ml) than subjects without depression (CRP: 0.79±0.34mg/dl; IL-6: 1.6±0.6pg/ml; p<0.001, respectively). In multivariate analysis, depression was positively correlated with CRP and IL-6 and IMT, and inversely associated with levels of SDANN. IMT is higher in depressed subjects, indicating that atherosclerosis is accelerated in this sub-group of patients. This is mainly due to patho-physiological mechanisms which connect depression and coronary artery disease, such as inflammation and imbalance of the autonomic nervous system.