Severely Depressed Young Patients Have Over Five Times Increased Risk for Stroke: A 5-Year Follow-Up Study
Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan. Biological psychiatry
(Impact Factor: 10.26).
09/2008; 64(10):912-5. DOI: 10.1016/j.biopsych.2008.07.006
This study aims to estimate the risk of developing stroke within 5 years of discharge among young patients ages 18 to approximately 44 who were hospitalized for depressive disorders.
Our study design features a study cohort and a comparison cohort. The study cohort included patients ages 18 to approximately 44 who were hospitalized with a principal diagnosis of depressive disorder (n = 827), whereas the comparison cohort consisted of 4,135 patients selected randomly (five for every depressed patient) and matched with the study group in terms of gender, age, and date of discharge. Each patient was tracked for 5 years after their discharge in 1998. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rates after adjusting for possible confounding factors.
During the 5-year follow-up period, 50 depressed patients (6.05% of the study cohort) and 48 non-depressed subjects (1.16% of the comparison cohort) developed strokes. The adjusted hazard of stroke was 5.43 (95% confidence interval = 3.47-8.51, p < .001) times greater for depressed patients than for non-depressed subjects.
Our findings show young patients ages 18 to approximately 44 who were hospitalized for depressive disorders were at over five times greater risk of developing stroke within 5 years of discharge compared with non-depressed age- and gender-matched subjects.
Available from: Cheng-Ta Li
- "Major depressive disorder (MDD) is increasingly recognized as a chronic, deteriorating illness with high comorbidity (Krishnan, 2003; Lee et al., 2008; Roose et al., 2001; Trivedi et al., 2007). Without sufficient treatment, residual symptoms of depression can lead to worsening outcomes, including higher relapse rates, suicidality (Kennedy and Paykel, 2004; Tranter et al., 2002; Trivedi et al., 2008), and diminished quality of life and psychosocial functioning (Hays et al., 1995; Kennedy and Paykel, 2004; McCall and Dunn, 2003). "
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ABSTRACT: Remission is the optimal outcome for major depressive disorder (MDD), but many patients do not improve appreciably despite treatment with medication. Treatment-resistant patients may experience deterioration in cognitive functions. Research has reported structural abnormalities in certain brain areas that may contribute to a poor clinical response. We hypothesize that there will be structural differences between patients able to achieve remission and those responding poorly to antidepressants. In the first voxel-based morphometric (VBM) study comparing remitting with non-remitting MDD, we investigated gray matter volume (GMV) differences between depressives to determine which structural abnormalities existed, and correlated these with diminished cognitive functioning. Of 44 adults with recurrent MDD, 19 had full remissions and 25 were non-remitters after a 6-week trial with antidepressant treatment. Remission was defined by 17-item Hamilton Depression Rating Scale scores of </=7 for at least 2 weeks. VBM and neuropsychological studies were conducted on all patients and 25 healthy controls. The patients who remitted revealed milder visual attention deficits than did controls. This correlated with reduced GMV in the left postcentral gyrus (Brodmann area, or BA, 3) and the bilateral medial/superior frontal gyrus (BA 6). The non-remitting patients had reduced GMV in the left dorsolateral prefrontal cortex (DLPFC, BA 9), and impaired acoustic and visual attention associated with GMV differences in several cortical regions, thalamus and amygdala/parahippocampal gyrus. These findings indicated that patients whose MDD remitted were cognitively and morphologically different from non-remitters. Voxel-based structural deficits in the left DLPFC may characterize a subgroup of people with recurrent MDD who respond poorly to antidepressants.
Available from: helsinki.fi
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ABSTRACT: This study was carried out to compare the fasting plasma glucose (FPG) and 2-h plasma glucose (2-h PG) criteria for diabetes with regard to their relation to stroke mortality and the incidence of ischemic and hemorrhagic stroke. In addition, the age-and gender difference in the incidence of coronary heart disease (CHD) and stroke and their relation with known cardiovascular disease risk factors and diabetes mellitus was examined. The study was a sub-data analysis of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study including 25 181 individuals, 11 844 (47%) men and 13 345 (53%) women aged 25 to 90 years, from 14 European cohorts. In individuals without a history of diabetes elevated 2-h post-challenge glucose was a better predictor of stroke mortality than elevated fasting glucose in men, whereas the latter was better than the former in women. Elevated FPG and 2-h PG levels were associated with an increased risk of ischemic stroke incidence. 2-h PG contributed to the risk more strongly than FPG. No relationship between hyperglycemia and the risk of hemorrhagic stroke was found. The risk of CHD and ischemic stroke incidence increased with age in both genders, but was higher in all age groups in men than in women. The gender difference was, however, more marked for CHD than for ischemic stroke. Age, smoking and diabetes contributed to the development of both CHD and ischemic stroke. Elevated cholesterol levels predicted CHD only, whereas elevated blood pressure was a risk predictor for the incidence of ischemic stroke. The CHD and ischemic stroke risk was higher in men than in women with and without diabetes, however, the gender difference diminished for CHD but enlarged for ischemic stroke in diabetic individuals. The known risk factors including diabetes contributed differently to the risk of CHD and ischemic stroke in women and in men. Hyperglycemia defined by FPG or 2-h PG increases the risk of ischemic stroke in individuals without diabetes. FPG better predicts stroke mortality in women and 2-h PG in men. The risk of acute CHD and ischemic stroke is higher in men than in women in all ages, but such gender difference is more marked for CHD than for ischemic stroke. CHD risk is higher in men than in women, but the difference is reduced in diabetic population. Diabetes, however, increases stroke risk more in men than in women in all ages. Ei saatavilla
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ABSTRACT: Depressive disorder (DD) is characterized by an inflammatory process and oxidative stress. Cyclooxygenase-2 (COX-2), the expression of which increases in depression, is an enzyme involved in inflammation and free radical processes. The aim of our study was to assess the correlation between single nucleotide polymorphism G-765C of the COX-2 gene and recurrent DD.
The study was carried out in a group of 181 patients treated for recurrent DD, and in 149 healthy subjects of the control group (CG). Polymerase chain reaction/restriction fragment length polymorphism was used for genotyping.
A statistically significant difference in genotype distribution was observed as a result of the comparison between the CG and the patients with DD. We demonstrated that the presence of the -765G allele in the COX-2 gene increased 2.1-fold the risk of DD development, whereas the presence of a homozygote (G-765G) in the analyzed gene increased the risk of DD development 2.5-fold.
According to the obtained results, it may be proposed with some caution that the presence of both the -765G allele and the G-765G genotype in the COX-2 gene may confer a susceptibility to an increased risk of recurrent DD in the Polish population.
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