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Association Between Clinical Depression and Endothelial Function Measured by Forearm Hyperemic Reactivity

From the Department of Psychology (K.L.L., R.P.), University of Québec at Montréal (UQAM), Montréal, Québec, Canada; Research Centre (K.L.L., R.P., A.A., J.D., S.L.B.), Montreal Heart Institute, Montréal, Québec, Canada; Research Center (K.L.L., S.L.B.), Division of Chest Medicine, Hôpital du Sacré-Coeur, Montréal, Québec, Canada; Department of Exercise Science (S.L.B.), Concordia University, Montréal, Québec, Canada.

Address correspondence and reprint requests to Kim L. Lavoie, Montreal Behavioral Medicine Center, Research Centre, Montreal Heart Institute, 5000 Bélanger East, Montréal, Québec, H1T 1C8 Canada. E-mail: k-lavoie{at}crhsc.rtss.qc.ca

Objective: To assess associations between clinically significant depression (major depressive disorder [MDD] and minor depressive disorder [MiDD]) and endothelial function (EF), via forearm hyperemic reactivity (FHR), in patients referred for myocardial perfusion imaging. Studies have linked MDD to impaired EF, an early marker of coronary heart disease (CHD) and risk factor for cardiac events, in healthy, noncardiac patients, although no studies have assessed the MDD-EF association in patients with or at risk for CHD.

Methods: Depression was assessed, using the Primary Care Evaluation of Mental Disorders structured interview in 323 patients (n = 242 men; mean age = 59 years) with or at risk for CHD. FHR was assessed, using a dynamic nuclear imaging technique that measures the dilatory capability of the brachial artery during hyperemic challenge. The relative uptake ratio (RUR) of blood flow between hyperemic and nonhyperemic arms was used to measure FHR.

Results: Patients with MDD and MiDD had lower RURs (mean values = 3.31 and 3.34, respectively), indicating poorer EF than patients without depression (mean = 4.27) (F = 5.19, p < .01), irrespective of CHD status. All results were adjusted for covariates including sociodemographic, medical, biochemical, and physiological variables.

Conclusions: Patients with clinical levels of depression had worse FHR than patients without depression, irrespective of CHD status and after adjusting for covariates. Data extend previous findings, suggesting that the link between clinical depression and worse CHD outcomes may be mediated by EF.

Key Words: depression • forearm hyperemic reactivity • endothelial function • coronary heart disease

Abbreviations: BDI = Beck Depression Inventory; CHD = coronary heart disease; CRP = C-reactive protein; DSM = Diagnostic and Statistical Manual; EF = endothelial function; FHR = forearm hyperemic reactivity; FMD = flow-mediated dilatation; HPA = hypothalamic-pituitary-adrenal; MDD = major depressive disorder; MiDD = minor depressive disorder; MI = myocardial infarction; NO = nitric oxide; PRIME-MD = Primary Care Evaluation of Mental Disorders; RUR = relative uptake ratio; SCID = Structured Clinical Interview for DSM; SPECT = single photon emission computed tomography.