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Consequences of Comorbidity of Elevated Stress and/or Depressive Symptoms and Incident Cardiovascular Outcomes in Diabetes: Results From the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.

TitleConsequences of Comorbidity of Elevated Stress and/or Depressive Symptoms and Incident Cardiovascular Outcomes in Diabetes: Results From the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsCummings, DM, Kirian, K, Howard, G, Howard, V, Yuan, Y, Muntner, P, Kissela, B, Redmond, N, Judd, SE, Safford, MM
JournalDiabetes Care
Volume39
Issue1
Pagination101-9
Date Published2016 Jan
ISSN1935-5548
KeywordsAfrican Americans, Aged, Cardiovascular Diseases, Cohort Studies, Comorbidity, Coronary Disease, Depression, Diabetes Mellitus, European Continental Ancestry Group, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Risk Factors, Stress, Psychological, Stroke
Abstract

OBJECTIVE: To evaluate the impact of comorbid depressive symptoms and/or stress on adverse cardiovascular (CV) outcomes in individuals with diabetes compared with those without diabetes.RESEARCH DESIGN AND METHODS: Investigators examined the relationship between baseline depressive symptoms and/or stress in adults with and without diabetes and physician-adjudicated incident CV outcomes including stroke, myocardial infarction/acute coronary heart disease, and CV death over a median follow-up of 5.95 years in the national REGARDS cohort study.RESULTS: Subjects included 22,003 adults (4,090 with diabetes) (mean age 64 years, 58% female, 42% black, and 56% living in the southeastern "Stroke Belt"). Elevated stress and/or depressive symptoms were more common in subjects with diabetes (36.8% vs. 29.5%; P < 0.001). In fully adjusted models, reporting either elevated stress or depressive symptoms was associated with a significantly increased incidence of stroke (HR 1.57 [95% CI 1.05, 2.33] vs. 1.01 [0.79, 1.30]) and CV death (1.53 [1.08, 2.17] vs. 1.12 [0.90, 1.38]) in subjects with diabetes but not in those without diabetes. The combination of both elevated stress and depressive symptoms in subjects with diabetes was associated with a higher incidence of CV death (2.15 [1.33, 3.47]) than either behavioral comorbidity alone (1.53 [1.08, 2.17]) and higher than in those with both elevated stress and depressive symptoms but without diabetes (1.27 [0.86, 1.88]).CONCLUSIONS: Comorbid stress and/or depressive symptoms are common in individuals with diabetes and together are associated with progressively increased risks for adverse CV outcomes.

DOI10.2337/dc15-1174
Alternate JournalDiabetes Care
PubMed ID26577418
PubMed Central IDPMC4876731
Grant ListP30-DK-093002 / DK / NIDDK NIH HHS / United States
HL R01080477 / HL / NHLBI NIH HHS / United States
K24 HL111154 / HL / NHLBI NIH HHS / United States
P30 DK093002 / DK / NIDDK NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
R01 HL080477 / HL / NHLBI NIH HHS / United States
UL1 TR001425 / TR / NCATS NIH HHS / United States
U01-NS-041588 / NS / NINDS NIH HHS / United States