Depressive symptoms were associated with a greater risk for peripheral arterial disease, according to study results. However, the direction of the association is unknown.
“We still don’t know which comes first,” study researcher Marlene Grenon, MD, CM, said in a press release. “Is it that patients with [peripheral arterial disease, (PAD)] become depressed because their mobility is impaired, or that people who are depressed engage in unhealthy behaviors such as smoking and lack of exercise, and are thus more at risk of developing PAD? Or might it be a vicious cycle, where one leads to the other?”
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Grenon, a vascular surgeon at San Francisco VA Medical Center, and colleagues from the University of California, San Francisco, used data from the Heart and Soul Study, a prospective cohort of 1,024 men and women with coronary artery disease.
Depressive symptoms were assessed using the nine-item Patient Health Questionnaire, and PAD was determined at baseline using self-reports. Participants were followed up for approximately 7 years, and events associated with PAD, including surgery, angioplasty, thrombolysis and exertional leg pain, were determined by reviewing medical records.
At baseline, 19% of patients had depressive symptoms. PAD was reported by 12% of patients with depressive symptoms and 7% of patients without depressive symptoms (OR=1.79; 95% CI, 1.06-3.04). The association between depression and PAD remained significant even after controlling for comorbid conditions, medications, PAD risk factors, inflammation and health behaviors, according to the researchers. During follow-up, PAD events occurred in 7% of patients with depression and 5% of patients without depression (HR=2.09; 95% CI, 1.09-4).
The researchers said the association between depression and PAD events could be partly explained by modifiable risk factors such as smoking and lack of physical activity.
“An emerging body of literature has suggested that depression is associated with greater risk of PAD and worse functional and postoperative outcomes among patients with PAD,” the researchers wrote. “Still, the mechanisms of this association are unknown.”
Grenon and colleagues said an important next step is to understand those mechanisms and identify effective interventions.
Disclosure: The researchers report no relevant financial disclosures.