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Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder.
Psychosom Med. 2005 Sep-Oct; 67(5):703-6.PM

Abstract

OBJECTIVE

An increased association between depression and cardiovascular disease, as well as cardiovascular risk factors, led to the "vascular depression" hypothesis. This subtype of depression is postulated to have a different clinical presentation and to be more treatment-resistant. In this study, we measured the impact of cardiovascular risk factors on the outcome of antidepressant treatment in major depressive disorder (MDD).

METHOD

We enrolled 348 MDD subjects, ages 19 to 65 years, in an 8-week treatment study with 20 mg fluoxetine per day. We recorded for each subject 6 cardiovascular risk factors: age (male > or =45, female > or =55), smoking, family history, hypertension, diabetes, hypercholesterolemia; and we defined a cardiovascular risk score (range, 0-6) by the number of risk factors present. Treatment outcome was measured as response (> or =50% improvement on the 17-item Hamilton Rating Scale for Depression [Ham-D-17]) and remission (final Ham-D-17< or =7).

RESULTS

In logistic regression analyses, the cardiovascular risk score was significantly associated with treatment nonresponse and lack of remission when adjusting for age of onset of MDD and baseline severity of depression. The cardiovascular risk score remained significantly associated with treatment nonresponse when we additionally controlled for overall medical burden (measured with the Cumulative Illness Rating Scale). Among individual cardiovascular risk factors, elevated total cholesterol was a significant predictor of treatment nonresponse and lack of remission.

CONCLUSION

Cardiovascular risk factors may have negative effects on the course of treatment in MDD. These results support the concept of "vascular depression" in younger subjects.

Authors+Show Affiliations

Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. diosifescu@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16204427

Citation

Iosifescu, Dan V., et al. "Cardiovascular Risk Factors May Moderate Pharmacological Treatment Effects in Major Depressive Disorder." Psychosomatic Medicine, vol. 67, no. 5, 2005, pp. 703-6.
Iosifescu DV, Clementi-Craven N, Fraguas R, et al. Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder. Psychosom Med. 2005;67(5):703-6.
Iosifescu, D. V., Clementi-Craven, N., Fraguas, R., Papakostas, G. I., Petersen, T., Alpert, J. E., Nierenberg, A. A., & Fava, M. (2005). Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder. Psychosomatic Medicine, 67(5), 703-6.
Iosifescu DV, et al. Cardiovascular Risk Factors May Moderate Pharmacological Treatment Effects in Major Depressive Disorder. Psychosom Med. 2005;67(5):703-6. PubMed PMID: 16204427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder. AU - Iosifescu,Dan V, AU - Clementi-Craven,Nicoletta, AU - Fraguas,Renerio, AU - Papakostas,George I, AU - Petersen,Timothy, AU - Alpert,Jonathan E, AU - Nierenberg,Andrew A, AU - Fava,Maurizio, PY - 2005/10/6/pubmed PY - 2006/7/19/medline PY - 2005/10/6/entrez SP - 703 EP - 6 JF - Psychosomatic medicine JO - Psychosom Med VL - 67 IS - 5 N2 - OBJECTIVE: An increased association between depression and cardiovascular disease, as well as cardiovascular risk factors, led to the "vascular depression" hypothesis. This subtype of depression is postulated to have a different clinical presentation and to be more treatment-resistant. In this study, we measured the impact of cardiovascular risk factors on the outcome of antidepressant treatment in major depressive disorder (MDD). METHOD: We enrolled 348 MDD subjects, ages 19 to 65 years, in an 8-week treatment study with 20 mg fluoxetine per day. We recorded for each subject 6 cardiovascular risk factors: age (male > or =45, female > or =55), smoking, family history, hypertension, diabetes, hypercholesterolemia; and we defined a cardiovascular risk score (range, 0-6) by the number of risk factors present. Treatment outcome was measured as response (> or =50% improvement on the 17-item Hamilton Rating Scale for Depression [Ham-D-17]) and remission (final Ham-D-17< or =7). RESULTS: In logistic regression analyses, the cardiovascular risk score was significantly associated with treatment nonresponse and lack of remission when adjusting for age of onset of MDD and baseline severity of depression. The cardiovascular risk score remained significantly associated with treatment nonresponse when we additionally controlled for overall medical burden (measured with the Cumulative Illness Rating Scale). Among individual cardiovascular risk factors, elevated total cholesterol was a significant predictor of treatment nonresponse and lack of remission. CONCLUSION: Cardiovascular risk factors may have negative effects on the course of treatment in MDD. These results support the concept of "vascular depression" in younger subjects. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/16204427/Cardiovascular_risk_factors_may_moderate_pharmacological_treatment_effects_in_major_depressive_disorder_ L2 - http://dx.doi.org/10.1097/01.psy.0000170338.75346.d0 DB - PRIME DP - Unbound Medicine ER -