Associations between arterial stiffness, depressive symptoms and cerebral small vessel disease: cross-sectional findings from the AGES-Reykjavik Study
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Key result
Greater arterial stiffness was significantly associated with a higher depressive symptom score (β 0.096 per SD increase in pulse wave velocity), an association partly explained by white matter hyperintensity volume and subcortical infarcts.
Population
2,058 older adults from the AGES-Reykjavik study second examination round without dementia.
Design
Cross-sectional
Authors
Discussion
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Implication
Arterial stiffness may contribute to depressive symptoms via cerebral small vessel disease; hypothesis-generating and should not yet change practice.
Key Points
- To examine whether arterial stiffness is associated with depressive symptoms in older adults and whether manifestations of cerebral small vessel disease explain this relationship.
- Conducted a cross-sectional study of 2,058 older adults (mean age 79.6 years; 59.0% women) participating in the AGES-Reykjavik study between 2007 and 2011.
- Measured arterial stiffness using carotid-femoral pulse wave velocity (CFPWV), depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15), and cerebral small vessel disease markers via brain MRI.
- Assessed mediation of the CFPWV–depression relationship by white matter hyperintensity volume, subcortical infarcts, cerebral microbleeds, Virchow-Robin spaces, and total brain parenchyma volume.
- Higher CFPWV was significantly associated with higher GDS-15 depression scores after adjustment for potential confounders (β = 0.096, 95% CI 0.005–0.187).
- Additional adjustment for white matter hyperintensity volume or subcortical infarcts attenuated the association between CFPWV and depressive symptoms to nonsignificance (p > 0.05), with formal mediation tests confirming significant attenuating effects.
- Virchow-Robin spaces, cerebral microbleeds, and total brain parenchyma volume did not mediate or explain the association between CFPWV and depressive symptoms.
Study Design
Type
Cross-Sectional (n=2,058)
Structured PICO
P
Population
2,058 older adults (mean age 79.6 years, 59% female) from the AGES-Reykjavik Study, free of dementia, assessed cross-sectionally for arterial stiffness, depressive symptoms, and cerebral small vessel disease.
E
Exposure
Arterial stiffness measured by carotid-femoral pulse wave velocity (CFPWV)
O
Outcome
Depressive symptoms assessed by the 15-item Geriatric Depression Scale (GDS-15) score as a continuous variablepatient reported
Main Result
Mean Difference: 0.096 (95% CI 0.005–0.187)
p-value: p=<0.05
Greater arterial stiffness is associated with more depressive symptoms in older adults, a relationship that is partly mediated by cerebral small vessel disease such as white matter hyperintensities and subcortical infarcts.
Limitations
- Cross-sectional design precludes conclusions about causal mediation or temporal association.
- Depressive symptoms were assessed by a self-report questionnaire rather than a structured interview.
- Potential biased attrition between the AGES-1 and -2 studies.
- Low level and severity of depressive symptoms in the study population may have reduced effect sizes.
- Potential misclassification of dichotomous depression scores due to high use of antidepressant medication for other reasons.
- Cross-sectional design precludes conclusions about causal mediation
- Depressive symptoms were assessed by a self-report questionnaire rather than a structured interview
Cite This Study
Sloten et al. (2016) conducted a cross-sectional in Depressive symptoms (n=2,058). Arterial stiffness (carotid-femoral pulse wave velocity) vs. Lower arterial stiffness was evaluated on Depressive symptoms (15-item Geriatric Depression Scale [GDS-15] score) (β 0.096, 95% CI 0.005-0.187, p=<0.05). Greater arterial stiffness was significantly associated with a higher depressive symptom score (β 0.096 per SD increase in pulse wave velocity), an association partly explained by white matter hyperintensity volume and subcortical infarcts.
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