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Research Paper

Arterial stiffness is associated with depression in middle-aged men — the Maastricht Study

Veronica Onete, Ronald M. Henry, Simone J.S. Sep, Annemarie Koster, Carla J. van der Kallen, Pieter C. Dagnelie, Nicolaas Schaper, Sebastian Köhler, Koen Reesink, Coen D.A. Stehouwer and Miranda T. Schram
J Psychiatry Neurosci March 01, 2018 43 (2) 111-119; DOI: https://doi.org/10.1503/jpn.160246
Veronica Onete
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Ronald M. Henry
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Simone J.S. Sep
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Annemarie Koster
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Carla J. van der Kallen
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Pieter C. Dagnelie
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Nicolaas Schaper
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Sebastian Köhler
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Koen Reesink
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Coen D.A. Stehouwer
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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Miranda T. Schram
From the Department of Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Schaper, Stehouwer, Schram); the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Onete, Henry, Sep, Kallen, Dagnelie, Schaper, Reesink, Stehouwer, Schram); the Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands (Henry, Reesink, Schram); the Department of Social Medicine, Maastricht University, Maastricht, the Netherlands (Koster); the School for Care and Public Health Research (CAPHRI), Maastricht University, Maastricht, the Netherlands (Koster, Dagnelie, Schaper); the Department of Epidemiology, Maastricht University, Maastricht, the Netherlands (Dagnelie); and the Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre (MUMC), and School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands (Köhler).
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  • Fig. 1
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    Fig. 1

    Selection of participants for inclusion in our analyses. cfPWV = carotid to femoral pulse wave velocity; MINI = Mini-International Neuropsychiatric Interview; PHQ-9 = Patient Health Questionnaire-9.

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    Fig. 2

    The association between carotid to femoral pulse wave velocity (cfPWV) and major depressive disorder stratified by age and sex. Men and women aged 60 years or younger have a higher risk of major depressive disorder, although this association was not significant for women. The presented odds ratios (ORs) were adjusted for age, type 2 diabetes, mean arterial pressure, heart rate, body mass index, lipid medication, smoking, prior cardiovascular disease, alcohol use and hypertension. SD = standard deviation.

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    Fig. 3

    The association between carotid to femoral pulse wave velocity (cfPWV) and depressive symptoms stratified by age and sex. Men and women aged 60 years or younger had a higher risk of depressive symptoms, although this association was not statistically significant for women. Rate ratios were adjusted for age, type 2 diabetes, mean arterial pressure, heart rate, body mass index, lipid medication, smoking, prior cardiovascular disease, alcohol use and hypertension. SD = standard deviation.

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    Table 1

    Demographic and clinical characteristics of the study population

    Group; mean ± SD or median [IQR]*
    CharacteristicNo depressive disorder (n = 2656)MDD (n = 101)
    Age, yr59.9 ± 8.158.6 ± 8.1
    Female sex, %48.647.5
    Education level, low/medium/high, %32/29/3949/30/22
    Cardio-metabolic risk factors
     BMI, kg/m226.9 ± 4.328.4 ± 5.1
     Waist:hip ratio0.94 ± 0.090.96 ± 0.10
     Glucose metabolism status, NGM/IGM/TDM2, %57/15/2741/10/49
     Total cholesterol, mmol/L5.24 ± 1.165.06 ± 1.13
     HDL cholesterol, mmol/L1.52 ± 0.471.36 ± 0.45
     LDL cholesterol, mmol/L3.10 ± 1.032.99 ± 1.14
     Total:HDL cholesterol ratio3.70 ±1.184.03 ± 1.35
     Systolic blood pressure, mm Hg135 ± 18136 ± 18
     Diastolic blood pressure, mm Hg76 ± 1077 ± 11
     Mean arterial pressure, mm Hg97 ± 1097 ± 11
     Heart rate, bpm63 ± 965 ± 10
     Hypertension, %55.258.4
     Prior CVD, %16.121.6
     eGFR, mL/min/1.73 m288.3 ± 14.787.8 ± 16.0
    Lifestyle factors
     Smoking, never/former/current, %34/53/1322/52/27
     Alcohol use, none/low/high, %17/56/2735/43/22
     Physical activity, hours/wk†13.3 [8.3–18.8]10.5 [6.0–16.5]
     High-intensity physical activity, hours/wk†4.5 [2.3–8.0]3.0 [0.8–5.5]
    Medication use
     Glucose lowering drugs, %21.742.6
     Anti-hypertensive drugs, %38.546.5
     Lipid modifying drugs, %36.243.6
     Antidepressive drugs, %‡6.4 (170)25.7 (26)
    Stiffness related indices
     cfPWV, m/s8.99 ± 2.149.52 ± 2.84
     Pulse pressure, mm Hg51 ± 1051 ± 10
    Depressive symptoms
     PHQ-9 score2.0 [0.0–4.0]10.0 [7.0–16.0]
    • BMI = body mass index; cfPWV = carotid to femoral pulse wave velocity; CVD = cardiovascular disease; eGFR = estimated glomerular filtration rate; HDL = high-density lipoprotein; IGM = impaired glucose metabolism; IQR = interquartile range; LDL = low-density lipoprotein; MDD = major depressive disorder; NGM = normal glucose metabolism; PHQ-9 = Patient Health Questionnaire-9; SD = standard deviation; TDM2 = type 2 diabetes mellitus.

    • ↵* Unless indicated otherwise.

    • ↵† Data on physical activity were available for 2409 participants.

    • ↵‡ Antidepressive drugs according to sex: 8.9% in nondepressed women v. 4.0% in nondepressed men and 33.3% in depressed women v. 18.9% in depressed men.

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    Table 2

    Association between carotid to femoral pulse wave velocity and major depressive disorder stratified by age and sex

    Age ≤ 60 yr; OR (95% CI)Age > 60 yr; OR (95% CI)
    Model*Men (n = 612, 27 cases)Women (n = 746, 35 cases)Men (n = 800, 21 cases)Women (n = 599, 18 cases)
    Model 12.49 (1.64–3.78)1.42 (0.95–2.10)1.41 (1.04–1.91)0.72 (0.44–1.19)
    Model 22.37 (1.54–3.64)1.27 (0.84–1.93)1.37 (0.99–1.90)0.54 (0.31–0.94)
    Model 32.23 (1.42–3.52)1.34 (0.84–2.15)1.33 (0.93–1.90)0.60 (0.33–1.08)
    Model 4†2.36 (1.45–3.84)1.57 (0.93–2.66)1.03 (0.63–1.68)0.64 (0.32–1.31)
    • CI = confidence interval; OR = odds ratio.

    • ↵* Model 1 = crude; Model 2 = adjusted for age, type 2 diabetes; Model 3 = additionally adjusted for mean arterial pressure; Model 4 = additionally adjusted for heart rate, body mass index, lipid medication, smoking, alcohol use, prior cardiovascular disease and hypertension.

    • ↵† A total of 111 participants (7 cases) equally distributed among the groups had missing values on covariates and dropped out of the analyses.

    • View popup
    Table 3

    The association between cfPWV and depressive symptoms stratified by age and sex

    Age ≤ 60 years; rate ratio (95% CI)Age > 60 years; rate ratio (95% CI)
    Model*Men (n = 582)Women (n = 722)Men (n = 761)Women (n = 579)
    Model 11.28 (1.11–1.48)1.13 (1.03–1.23)1.12 (1.01–1.23)1.02 (0.93–1.12)
    Model 21.22 (1.04–1.42)1.09 (0.996–1.21)1.07 (0.96–1.20)0.98 (0.90–1.07)
    Model 31.28 (1.09–1.52)1.12 (0.996–1.25)1.04 (0.92–1.17)1.00 (0.90–1.11)
    Model 4†1.28 (1.09–1.52)1.11 (0.99–1.23)0.96 (0.84–1.08)1.00 (0.90–1.12)
    • CI = confidence interval.

    • ↵* Model 1 = crude; Model 2 = adjusted for age, type 2 diabetes; Model 3 = additionally adjusted for mean arterial pressure; Model 4 = additionally adjusted for heart rate, body mass index, lipid medication, smoking, alcohol use, prior cardiovascular disease and hypertension.

    • ↵† A total of 90 participants equally distributed among the groups had missing values on covariates and dropped out of the analyses.

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Journal of Psychiatry and Neuroscience: 43 (2)
J Psychiatry Neurosci
Vol. 43, Issue 2
1 Mar 2018
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Arterial stiffness is associated with depression in middle-aged men — the Maastricht Study
Veronica Onete, Ronald M. Henry, Simone J.S. Sep, Annemarie Koster, Carla J. van der Kallen, Pieter C. Dagnelie, Nicolaas Schaper, Sebastian Köhler, Koen Reesink, Coen D.A. Stehouwer, Miranda T. Schram
J Psychiatry Neurosci Mar 2018, 43 (2) 111-119; DOI: 10.1503/jpn.160246

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Arterial stiffness is associated with depression in middle-aged men — the Maastricht Study
Veronica Onete, Ronald M. Henry, Simone J.S. Sep, Annemarie Koster, Carla J. van der Kallen, Pieter C. Dagnelie, Nicolaas Schaper, Sebastian Köhler, Koen Reesink, Coen D.A. Stehouwer, Miranda T. Schram
J Psychiatry Neurosci Mar 2018, 43 (2) 111-119; DOI: 10.1503/jpn.160246
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