Prospective study of depressive symptoms and incident cardiovascular diseases in people with type 2 diabetes

Background: To prospectively examine whether depressive symptoms were associated with higher risks of incident cardiovascular diseases (CVD) in individuals with type 2 diabetes.

Methods: Included were 17,031 participants from UK Biobank with type 2 diabetes who were free of depression (identified by self-reported medical history, hospital record, and antidepressant use), and composite CVD, including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Cox proportional hazards models were applied to examine the association between depressive symptoms measured by Patient Health Questionaire-2 (PHQ-2) and incident composite CVD and its subtypes, adjusting for potential confounders.

Results: During a median follow-up of 12.3 years, we documented 2875 incident composite CVD cases (including 1303 coronary artery disease, 531 ischemic stroke, 530 peripheral arterial disease, and 1142 HF cases). The presence of depressive symptoms had higher risks of composite CVD (adjusted HR, 1.34; 95 % CI, 1.17-1.54) among individuals with type 2 diabetes. Dose-response relationships were observed between depressive symptoms and the composite CVD, ASCVD, and three individual CVD outcomes (P-trend <0.05 for all).

Conclusions: Depressive symptoms were associated with a higher risk of CVD events across all degrees of metabolic control and diabetes severity. Dose-response associations were also found between depressive symptoms score and all incident CVD outcomes, except for ischemic stroke, after adjustment for cardiovascular and diabetes-related risk factors. Therefore, simple screening questions regarding depressive symptoms might be applied to people with type 2 diabetes to predict CVD outcomes.