RESEARCH - Association between depression and coronary artery calcification in women with SLE

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Rheumatology Advance Access originally published online on March 13, 2009

Rheumatology 2009 48(5):576-581; doi:10.1093/rheumatology/kep020

Association between depression and coronary artery calcification in

women with systemic lupus erythematosus

Carol M. Greco1, Amy H. Kao2, Abdus Sattar3, Natalya Danchenko4,

Kathleen M. Maksimowicz-McKinnon2, Edmundowicz5, Kim

Sutton-Tyrrell3, P. 6, H. Kuller3 and

Manzi2,3

1Department of Psychiatry, 2Department of Medicine, Division of

Rheumatology and Clinical Immunology, University of Pittsburgh School

of Medicine, 3University of Pittsburgh Graduate School of Public

Health, Pittsburgh, PA, USA, 4Lundbeck SAS, Paris, France, 5University

of Pittsburgh Cardiovascular Institute, Pittsburgh, PA and 6University

of Vermont, Burlington, VT, USA.

Abstract

Objectives. To determine the associations between depression,

cardiovascular risk factors and coronary artery calcification (CAC) in

women with SLE and controls.

Methods. CAC was measured using electron-beam CT (EBCT). Traditional,

inflammatory and lupus-related risk factors as well as depressive

symptoms (Center for Epidemiologic Studies Depression Scale—CES-D)

were measured at a single study visit in 161 women with SLE and 161

age- and race frequency-matched female healthy controls.

Results. Women with SLE reported more depressive symptoms than

controls, with 27% of SLE and 15% of controls having CES-D scores

suggestive of clinical depression. SLE women were more likely to have

CAC, as well as more severe CAC compared with controls. Among the SLE

women, depression was associated with greater than 2-fold odds of

having any CAC [odds ratio (OR) 2.48; 95% CI 1.05, 5.87; P = 0.04],

independent of traditional risk factors (age, hypertension and

triglycerides) and inflammatory markers. However, when BMI was

included among the covariates, the association between depression and

CAC was attenuated, indicating the potential mediating role of BMI.

Depression was not a risk factor for CAC in controls.

Conclusions. In women with SLE, depression was associated with CAC.

This association was mediated by BMI. Depression and adiposity may add

to the inflammatory burden of SLE, thus contributing to cardiovascular

disease risk.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/5/576?etoc

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