Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Cardiovascular Risk and Depression in Systemic Lupus Erythematosus (SLE)
Julian, L. J., Katz, P.P., Yazdany, J., Hersh, A.O., Trupin, L., Galvin, A., Criswell, L.A.
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.
Table 1. Logistic regression analyses predicting "incident depression".
| OR | CI (95%) | Sig. | |
|---|---|---|---|
| Step 1: Demographics | |||
| Female | .54 | .23–1.25 | .15 |
| College degree | 1.15 | .68–1.96 | .61 |
| Age | .98 | .96–1.01 | .14 |
| Below poverty | 3.26 | 1.23–8.24 | .01 |
| Caucasian | .72 | .40–1.29 | .27 |
| Step 2: Traditional CV risk | |||
| MI or stroke | 2.00 | 1.01–3.96 | .05 |
| CV risk factor sum | .99 | .83–1.20 | .94 |
| Step 3: SLE-specific CV risk | |||
| History of clot | .92 | .50–1.72 | .80 |
| Renal involvement | 1.02 | .61–1.71 | .94 |
| Disease activity | 1.12 | 1.07–1.16 | <.0001 |
| Disease duration | 1.01 | .98–1.04 | .51 |
| Step 4: | |||
| Interaction: CV event × poverty | 6.31 | .73–54.2 | .09 |
Conclusion:
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.
To cite this abstract, please use the following information:
Julian, L. J., Katz, P.P., Yazdany, J., Hersh, A.O., Trupin, L., Galvin, A., et al; Cardiovascular Risk and Depression in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1983
DOI: 10.1002/art.27056
