February 20, 2019
2 min read

Depression confers amputation, mortality risk in PAD

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S. Marlene Grenon
S. Marlene Grenon

Among patients with peripheral artery disease, those with depression had greater risk for amputation and mortality than those without PAD, researchers reported.

“Depression is an under-recognized risk factor for PAD,” S. Marlene Grenon, MD, an associate clinical professor with the University of California, San Francisco, and chief medical officer of Evry Health, said in a press release. “Our recent findings demonstrate that PAD patients with depression are at a higher risk of long-term death and amputation. It’s important to better understand the effect of mental health disorders in cardiovascular diseases and find the best solutions.”

Grenon and colleagues conducted an observational retrospective cohort study of 155,647 patients from Veterans Health Administration hospitals (mean age, 67 years; 98% men) diagnosed with incident PAD between 2003 and 2014. Patients were stratified by whether they had a diagnosis of depression.

The primary outcomes were major amputation and mortality. Median follow-up was 5.9 years.

According to the researchers, 16% of the cohort had depression, and there were 9,517 amputations and 63,287 deaths during the study period.

After adjustment for covariates, patients who were diagnosed with depression at the same time they were diagnosed with PAD had elevated risk for major amputation (adjusted HR = 1.13; 95% CI, 1.07-1.19) and mortality (aHR = 1.17; 95% CI, 1.14-1.2) compared with those without depression diagnosis, Grenon and colleagues wrote.

Among patients taking medication for depression, risk for amputation remained elevated compared with the group without depression, but to a lesser degree (aHR = 1.1; 95% CI, 1.03-1.17), according to the researchers.

Patients taking antidepressants for indications other than depression had higher risk for amputation compared with patients without depression and those not taking antidepressants (aHR = 1.08; 95% CI, 1.03-1.14), the researchers wrote.

Compared with patients who were not diagnosed with depression or not taking antidepressants for any reason, patients with depression or taking antidepressants for any indication had an 18% to 25% higher mortality risk, Grenon and colleagues wrote.

“We still have so much to learn about the relationship between PAD and depression, but there is definitely something there. In fact, I believe that depression and stress can impact several other chronic diseases,” Grenon said in the release. “There is a need to screen and address behavioral health issues in our patients because it can impact their response to treatment as well as their quality of life, their work and their loved ones. New approaches are being sought through digital health, for example, that may offer good solutions, particularly as we consider our fast pace of life. We need now to look at all these data and see where to go next to address this rising population health concern.“ – by Erik Swain

Disclosures: The authors report no relevant financial disclosures.