Are Lupus, Depression Linked To Atherosclerosis in Women?

PHILADELPHIA – Patients with systemic lupus erythematosus who are also diagnosed with depression were nearly four times more likely to have subclinical atherosclerosis than were lupus patients without depression in a cross-sectional study with 161 women with lupus.

“Depression may be a component of the 'lupus factor' that increases risk for cardiovascular disease,” Carol M. Greco, Ph.D., said at the annual meeting of the American College of Rheumatology. “Depressive symptoms may add to the inflammatory burden” of systemic lupus erythematosus, said Dr. Greco, a clinical psychologist at the lupus center of the University of Pittsburgh.

Finding evidence of a role for depression in causing atherosclerosis in patients with SLE is important because depression is a modifiable risk factor that can be targeted for intervention, she added. Her group's next step is to follow these interactions in a longitudinal clinical study.

To examine correlates of preclinical atherosclerosis in women with SLE, Dr. Greco and her associates studied 161 lupus patients with no history of a cardiovascular event. The women had enrolled in the HEARTS (Heart Effects on Atherosclerosis and Risk of Thrombosis in SLE) study at the University of Pittsburgh. At their baseline examination in 2001-2005, their average age was 50 years; 88% were white. Their average waist:hip ratio (a measure of adiposity) was 0.85, 55% were hypertensive, and 36% had a history of smoking. Their average duration of SLE was 16 years, with an average SLE disease activity index of 2.0. Two-thirds of the women received steroid treatment, and among these patients the median duration on a steroid was 10 years.

The researchers assessed depression with the 20-item CES-D (Centers for Epidemiologic Study–Depression) scale. In Dr. Greco's analysis, patients who scored 16 or higher on the CES-D were diagnosed with depression, and among the 161 patients in the study 27% met this criterion.

Depression might be relatively common among patients with SLE as a manifestation of central nervous system involvement of the disease, or because medications used to treat SLE may contribute to mood symptoms, Dr. Greco said.

The researchers diagnosed atherosclerosis by two measures: coronary artery calcium detected by electron beam CT, and carotid artery plaque visualized with ultrasound. Patients with either a coronary artery calcium Agatston score greater than zero or a carotid plaque index score of at least 1, or both, were considered to have atherosclerosis. In the study, 63% of the patients met this standard for having atherosclerosis.

Depression was among the strongest factors. Lupus patients with a CES-D score of 16 or higher had a significant and independent 3.85-fold greater risk for atherosclerosis, compared with patients without depression.

PHILADELPHIA – Patients with systemic lupus erythematosus who are also diagnosed with depression were nearly four times more likely to have subclinical atherosclerosis than were lupus patients without depression in a cross-sectional study with 161 women with lupus.

“Depression may be a component of the 'lupus factor' that increases risk for cardiovascular disease,” Carol M. Greco, Ph.D., said at the annual meeting of the American College of Rheumatology. “Depressive symptoms may add to the inflammatory burden” of systemic lupus erythematosus, said Dr. Greco, a clinical psychologist at the lupus center of the University of Pittsburgh.

Finding evidence of a role for depression in causing atherosclerosis in patients with SLE is important because depression is a modifiable risk factor that can be targeted for intervention, she added. Her group's next step is to follow these interactions in a longitudinal clinical study.

To examine correlates of preclinical atherosclerosis in women with SLE, Dr. Greco and her associates studied 161 lupus patients with no history of a cardiovascular event. The women had enrolled in the HEARTS (Heart Effects on Atherosclerosis and Risk of Thrombosis in SLE) study at the University of Pittsburgh. At their baseline examination in 2001-2005, their average age was 50 years; 88% were white. Their average waist:hip ratio (a measure of adiposity) was 0.85, 55% were hypertensive, and 36% had a history of smoking. Their average duration of SLE was 16 years, with an average SLE disease activity index of 2.0. Two-thirds of the women received steroid treatment, and among these patients the median duration on a steroid was 10 years.

The researchers assessed depression with the 20-item CES-D (Centers for Epidemiologic Study–Depression) scale. In Dr. Greco's analysis, patients who scored 16 or higher on the CES-D were diagnosed with depression, and among the 161 patients in the study 27% met this criterion.

Depression might be relatively common among patients with SLE as a manifestation of central nervous system involvement of the disease, or because medications used to treat SLE may contribute to mood symptoms, Dr. Greco said.

The researchers diagnosed atherosclerosis by two measures: coronary artery calcium detected by electron beam CT, and carotid artery plaque visualized with ultrasound. Patients with either a coronary artery calcium Agatston score greater than zero or a carotid plaque index score of at least 1, or both, were considered to have atherosclerosis. In the study, 63% of the patients met this standard for having atherosclerosis.

Depression was among the strongest factors. Lupus patients with a CES-D score of 16 or higher had a significant and independent 3.85-fold greater risk for atherosclerosis, compared with patients without depression.

PHILADELPHIA – Patients with systemic lupus erythematosus who are also diagnosed with depression were nearly four times more likely to have subclinical atherosclerosis than were lupus patients without depression in a cross-sectional study with 161 women with lupus.

“Depression may be a component of the 'lupus factor' that increases risk for cardiovascular disease,” Carol M. Greco, Ph.D., said at the annual meeting of the American College of Rheumatology. “Depressive symptoms may add to the inflammatory burden” of systemic lupus erythematosus, said Dr. Greco, a clinical psychologist at the lupus center of the University of Pittsburgh.

Finding evidence of a role for depression in causing atherosclerosis in patients with SLE is important because depression is a modifiable risk factor that can be targeted for intervention, she added. Her group's next step is to follow these interactions in a longitudinal clinical study.

To examine correlates of preclinical atherosclerosis in women with SLE, Dr. Greco and her associates studied 161 lupus patients with no history of a cardiovascular event. The women had enrolled in the HEARTS (Heart Effects on Atherosclerosis and Risk of Thrombosis in SLE) study at the University of Pittsburgh. At their baseline examination in 2001-2005, their average age was 50 years; 88% were white. Their average waist:hip ratio (a measure of adiposity) was 0.85, 55% were hypertensive, and 36% had a history of smoking. Their average duration of SLE was 16 years, with an average SLE disease activity index of 2.0. Two-thirds of the women received steroid treatment, and among these patients the median duration on a steroid was 10 years.

The researchers assessed depression with the 20-item CES-D (Centers for Epidemiologic Study–Depression) scale. In Dr. Greco's analysis, patients who scored 16 or higher on the CES-D were diagnosed with depression, and among the 161 patients in the study 27% met this criterion.

Depression might be relatively common among patients with SLE as a manifestation of central nervous system involvement of the disease, or because medications used to treat SLE may contribute to mood symptoms, Dr. Greco said.

The researchers diagnosed atherosclerosis by two measures: coronary artery calcium detected by electron beam CT, and carotid artery plaque visualized with ultrasound. Patients with either a coronary artery calcium Agatston score greater than zero or a carotid plaque index score of at least 1, or both, were considered to have atherosclerosis. In the study, 63% of the patients met this standard for having atherosclerosis.

Depression was among the strongest factors. Lupus patients with a CES-D score of 16 or higher had a significant and independent 3.85-fold greater risk for atherosclerosis, compared with patients without depression.