Newswise — People who suffer from both lupus and depression could experience additional health problems, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, Pa.
Systemic lupus erythematosus, also called SLE or lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women, typically developing in individuals in their twenties and thirties – prime child-bearing age.
Two independent research teams have recently looked at depression as a risk factor for additional health problems in patients with lupus.
In the first study, researchers evaluated the biological and psychological risk factors associated with atherosclerosis—the presence of carotid plaque or coronary artery calcium— in women with lupus.
Women with lupus have increased rates of atherosclerosis when compared to those who do not have lupus, and they also have a higher prevalence of depression. The researchers, from the University of Pittsburgh, looked at 161 women with lupus who had no prior history of cardiac events. These women were, on average, 50 years old, and 88 percent were Caucasian. They had lupus, on average, for 16 years. Most of the women (68 percent) had taken corticosteroids.
Participants were examined for cardiovascular risk factors, lupus activity and depression. Additionally, they received a scan of their coronary arteries—to determine the presence of coronary artery calcium—and a carotid artery ultrasound to detect the presence of plaque in the arteries.
Researchers found that 27 percent of the women studied had meaningful symptoms of depression and 63 percent of the women studied had atherosclerosis. They also determined that women with lupus who were depressed were at nearly four-fold risk for having artherosclerosis.
“This is the first study that links depression with early atherosclerosis in lupus,” explains Carol M. Greco, PhD; assistant professor of psychiatry, licensed psychologist; UPMC Shadyside Center for Integrative Medicine, Pittsburgh, Pa., and lead investigator in this study. “This is very exciting, because depression is a treatable problem. If we help people with lupus to reduce their depressive symptoms in addition to helping them with general disease management, maybe this will impact their risk for cardiovascular disease.”
In the second study, researchers from the University of California, San Francisco, noted that while the link between cardiovascular disease and depression is well established in the general population, few studies evaluated this relationship specifically among people with lupus.
They followed 725 patients with lupus who participated in annual survey interviews over five years. The participants were on average 50 years old; 60 percent were college educated; 74 percent were Caucasian; and 11 percent were living below the poverty level.
Over the course of the study, there were 163 new “cases” of depression estimated using a proxy screening measure for depression. Researchers noted that living in poverty, traditional cardiovascular risk and disease, and lupus disease activity were all significant predictors of depression in the participants. The important link between social factors and biological outcomes was highlighted by the observation that 80 percent of the lupus patients living below the poverty level who also had cardiovascular health problems developed depression during the study.
“We think that the findings from this study are exciting on a few levels,” explains Laura Julian, PhD; assistant Professor, department of medicine/ rheumatology; University of California, San Francisco, San Francisco, Calif., and lead investigator in the study. “First, this study underscores the fact that both social and biological factors are relevant for depression in lupus. There is likely a confluence of these factors, where social and biological factors interact leaving some patients at risk for depression, which contributes to overall disability. Also, this study highlights the relationships among cardiovascular disease and depression in lupus, which is probably dynamic and bidirectional. Finally, I think that studies like this provide clues to risk factors that are potentially modifiable. We have the potential to alleviate depression, improve health, and ultimately improve the lives of our patients.”
The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.
Editor’s Notes: Dr. Julian will present “Cardiovascular Risk and Depression in Systemic Lupus Erythematosus (SLE)” at 8:00 AM and Dr. Greco will present “Depression Is a Risk Factor for Subcinical Atherosclerosis in SLE” at 8:15 AM on Wednesday, October 21 during the ACR Annual Scientific Meeting at the Pennsylvania Convention Center in room 106 A.
Presentation Number: 1984
Depression Is a Risk Factor for Subclinical Atherosclerosis in SLE
Carol M. Greco, PhD, Ctr for Integrative Medicine, University of Pittsburgh, Pittsburgh, PA Tracy Li, PhD, Global Epidemiology & Outcomes, Bristol-Myers Squibb, Princeton, NJ Abdus Sattar, MS, Biostatistics, University of Pittsburgh, Pittsburgh, PA Amy H. Kao, MD, MPH, Rheumatology, University of Pittsburgh, Pittsburgh, PA Susan Manzi, MD, MPH, Rheumatology, University of Pittsburgh, Pittsburgh, PA
Purpose: Women with SLE have increased rates of subclinical atherosclerosis compared to controls, as measured by coronary artery calcium (CAC) and carotid plaque. Women with SLE also exhibit higher prevalence of depression and depressive symptoms than controls. Although depression and other psychological factors have been linked to atherosclerosis in healthy women, the associations between psychological factors and vascular disease in SLE remain largely unexplored. The purpose of this study was to evaluate biological and psychological risk factors associated with subclinical atherosclerosis in women with SLE, as defined by presence of coronary artery calcium and/or carotid plaque.
Method: In this cross-sectional study, 161 women with SLE without prior history of cardiac events completed comprehensive cardiovascular risk factor assessments, SLE disease activity assessments, and the Center for Epidemiologic Studies Depression scale (CES-D). Participants also completed an electron-beam computed tomography scan of the coronary arteries to determine the presence of CAC, and carotid artery ultrasound to detect presence of plaque. For this study, subclinical atherosclerosis was defined as having either or both of these vascular indicators. In unadjusted logistic regression analyses, risk factors associated with atherosclerosis at p<0.15 were evaluated for inclusion in multivariable models. The final model was selected based on Akaike's Information Criteria (AIC).
Results: The mean age of the participants was 50 years, and 88% were Caucasian. Mean SLE duration was 16 years. Most (68%) had taken corticosteroids, with median duration of 10 years of use. The mean CES-D score was 11.6 (SD= 9), with 27% of the participants scoring ≥ 16, a score consistent with clinically meaningful depressive symptoms. One hundred and one (63%) met criteria for subclinical atherosclerosis. Using multivariable logistic regression, SLE women with depression were at nearly four-fold risk for having subclinical atherosclerosis (OR= 3.85, 95% CI =1.37, 10.87) after adjustment for several traditional cardiovascular risk factors (age, hypertension, years of education), C-reactive protein (CRP), and waist-to-hip ratio.
Conclusion: Depression is associated with subclinical atherosclerosis in women with SLE, independent of age, education, hypertension, CRP and adiposity. This is important in that mental health factors are modifiable. Interventions that reduce depressive symptoms may impact cardiovascular disease in SLE.
Multivariable logistic regression analysis of risk factors for atherosclerosis in women with SLE (N=161). (View press release and full abstract at www.rheumatology.org).
Disclosure: C. M. Greco, Bristol-Myers Squibb, 2, National Institutes of Health, 2 ; T. Li, Bristol-Myers Squibb, 3 ; A. Sattar, Bristol-Myers Squibb, 2 ; A. H. Kao, NIH, 2 ; S. Manzi, Amgen, 2, Aspreva, 2, Genelabs Technologies, Inc., 2, Genentech Inc., 2, Human Genome Sciences, Inc., 2, Immunomedics, Inc., 2, Bristol-Myers Squibb Company, 2, Cellatope Corporation, 5, La Jolla Pharmaceutical, 5, MedImmune, Inc., 5, Genelabs Inc., 5, Genentech Inc., 5, Bristol-Myers Squibb, 5, Human Genome Sciences, 5, Centocor, Inc., 5, Cephalon, 5 .
Presentation Number: 1983
Cardiovascular Risk and Depression in Systemic Lupus Erythematosus (SLE)
L. J. Julian, PhD, Rheumatology, UCSF, SF, CA P.P. Katz, PhD, Rheumatology, UCSF, SF, CA J. Yazdany, MD, MPH, Rheumatology, UCSF, SF, CA A.O. Hersh, MD, Ped Rheum/ Box U127, UCSF, SF, CA L. Trupin, MPH, Rheumatology, UCSF, SF, CA A. Galvin, MSc, Rheumatology, UCSF, SF, CA L.A. Criswell, MD, MPH, Rheumatology, UCSF, SF, CA E.H. Yelin, PhD, Rheumatology, UCSF, SF, CA
Purpose: Cardiovascular (CV) disease has emerged as a major cause of morbidity and mortality in SLE. In the general population, the link between depression and CV disease is well established; however, few studies have evaluated this relationship in SLE. This study evaluated traditional and SLE-specific factors as predictors of the prevalence and incidence of depression in a large observational cohort of persons with SLE.
Methods: Participants included 725 persons with confirmed SLE (ACR criteria), participating in annual survey interviews over 6 years. Depression symptom severity was evaluated by the Centers for Epidemiological Studies Depression Scale (CESD). Statistical analyses included multivariate linear regression predicting concurrent depression, and logistic regression predicting incident depression (defined as a new onset of CESD score ≥23 over 2 years of follow up). Predictors in both models included sociodemographic characteristics, traditional risk factors (CV event, heart disease, hypertension, hypercholesterolemia, diabetes, obesity, family history, current or past smoking), and SLE-specific risk factors (renal involvement, history of clot, disease duration, disease activity).
Results: Mean age was 50±12, 60% were at least college educated, 74% were Caucasian, and 11% were living below poverty. In multivariate linear regression, living in poverty, history of CV event, traditional CV risk factors and disease activity were significant predictors of concurrent depression symptom severity, accounting for 34% of the variance (p<.0001). Over the course of the study there were 163 new ‘cases’ of incident depression. In multivariate logistic regression, predictors of incident depression included poverty status, history of myocardial infarction or stroke, and disease activity (Table 1). The interaction of CV event and poverty neared significance (p=.09). Descriptive analyses suggested that 80% of persons living below poverty with a history of a CV event developed depression during the study period.
Conclusions: Traditional and SLE-specific CV risk factors are associated with concurrent and incident depression. Participants at greatest risk for the development of depression are described by the confluence of sociodemographic and biological risk factors. Importantly, a number of CV risk factors are modifiable, highlighting the potential of both medical and social interventions to prevent the development of depression and/or to reduce the morbidity associated with depression in SLE.
Table 1. (View press release and full abstract at www.rheumatology.org).
Disclosure: L. J. Julian, None; P. P. Katz, None; J. Yazdany, None; A. O. Hersh, None; L. Trupin, None; A. Galvin, None; L. A. Criswell, None; E. H. Yelin, None.
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