Depression in late life has been associated with vascular abnormalities.
Several studies have demonstrated that persons with brain infarcts are more
likely to have depressive disorders. Furthermore, depression is related to
the subsequent development of ischemic heart disease.
To investigate the relationship between atherosclerosis at different
locations and depression in the general population.
Cross-sectional population-based study.
The Rotterdam Study, a population-based cohort study.
In 4019 men and women 60 years and older, we assessed atherosclerosis
at different locations, including common carotid intima-media thickness, plaques
in the carotid arteries, the ankle-brachial blood pressure index, and aortic
atherosclerosis. An overall measure of extracoronary atherosclerosis was obtained
in 3747 persons by computing the principal component of these extracoronary
atherosclerosis measures. In a subgroup of 1986 persons, we additionally measured
Main Outcome Measure
All subjects were screened for depressive symptoms. Screen-positive
subjects had a psychiatric interview to diagnose depressive disorder.
More severe extracoronary atherosclerosis was associated with a higher
prevalence of depressive disorders. For every 1–standard deviation increase,
the prevalence increased by 30%. Furthermore, we found a strong relationship
of severe coronary and aortic calcifications with depressive disorders (odds
ratio, 3.89; 95% confidence interval, 1.55-9.77; and odds ratio, 2.00; 95%
confidence interval, 1.02-3.96, respectively).
Atherosclerosis and depression are associated in the elderly. This finding
is compatible with the vascular depression hypothesis. However, the cross-sectional
nature of the study does not allow causal inferences. In particular, earlier
depressive episodes may have contributed to the development of atherosclerosis.