Biological markers and cardiovascular risk factors in relation to Type D personality, major depressive disorder and anxiety disorders : A cross-sectional clinical epidemiological study in persons at high risk for sleep apnea - Akershus Sleep Apnea Project
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AbstractPsychological distress is associated with increased risk for incident and recurrent cardiovascular events. Still, the mechanisms are poorly defined, particularly in a community-based setting. Increased systemic inflammation and autonomic dysfunction have been suggested as pathophysiological pathways, but current biomarkers cannot fully explain the increased risk. Also, the independent roles played by different psychological factors remain uncertain.
The present study aimed to assess the associations between psychosocial factors, traditional cardiovascular risk factors and novel cardiac biomarkers in a community-based sample (Akershus Sleep Apnea Project). Anxiety, depressive symptoms and Type D personality were evaluated in 535 persons, while major depressive disorder (MDD) was evaluated in a subset. Objective sleep registrations were performed.
Participants with Type D personality had a les healthy life-style, as well as increased level of C-reactive protein, higher average long-term heart rate and higher prevalence of complex ventricular ectopies, independent of anxiety. Furthermore, persons with co-morbid MDD and anxiety had higher levels of C-reactive protein than persons with one of these diagnoses or no diagnoses. We found no association between depression and heart rate variability or novel cardiac biomarkers including cardiac troponin T, adiponectin, osteoprotegerin and a panel of 17 cytokines.
The data suggest that Type-D personality alone or mediated by unhealthy behavior may increase systemic inflammation and promote arrhythmias. The cardiac biomarkers investigated are unlikely to contribute to the cardiovascular risk specifically induced by depression. Co-morbid MDD and anxiety may be a subgroup of psychologically distressed prone to inflammatory activity contributing to increased risk for cardiovascular disease. Objective sleep disturbances seem not to mediate any of these associations.
List of papers. Papers I, III and IV are removed from the thesis due to copyright restrictions.
Paper I Prevalence of cardiovascular risk factors and concentration of C-reactive protein in Type D personality persons without cardiovascular disease. Gunnar Einvik, Toril Dammen, Harald Hrubos-Strøm, Silje K Namtvedt, Anna Randby, Håvard A Kristiansen, Virend K Somers, Inger H Nordhus, Torbjørn Omland. Eur J Cardiovasc Prev 2011; 18:504-9 doi:10.1177/1741826710389383
Paper II Type D personality is associated with an increased prevalence of ventricular arrhythmias in community-residing persons without coronary heart disease. Gunnar Einvik, Toril Dammen, Silje K Namtvedt, Harald Hrubos-Strøm, Anna Randby, Håvard A Kristiansen, Inger H Nordhus, Virend K Somers, Torbjørn Omland. Submitted manuscript, published in: Eur J Prev Cardiol. 2012 Sep 24. [Epub ahead of print] doi:10.1177/2047487312462800
Paper III Major depressive disorder, anxiety and cardiac biomarkers in subjects at high risk of obstructive sleep apnea. Gunnar Einvik, Harald Hrubos-Strøm, Anna Randby, Inger H Nordhus, Virend K Somers, Torbjørn Omland, Toril Dammen. Psychosom Med 2011; 73:348-53. doi:10.1097/PSY.0b013e318219e64e
Paper IV Circulating cytokine concentrations are not associated with major depressive disorder in a community-based cohort at high risk for somatic co-morbidities Gunnar Einvik, Maria Vistnes, Harald Hrubos-Strøm, Anna Randby, Silje K Namtvedt, Inger H Nordhus, Virend K Somers, Toril Dammen, Torbjørn Omland. Gen Hosp Psychiatr 2012;34:262-7. doi:10.1016/j.genhosppsych.2012.01.017