Abstract
Depression and cardiovascular disease (CVD) are closely associated, but the mechanisms underlying this connection are unclear. Regardless of the low cholesterol levels observed in depression, a small particle size of low-density lipoproteins (LDL), as well as elevated apolipoprotein B (ApoB) levels, are related to increased CVD risk, even when levels of LDL cholesterol are low. We examined the association between elevated depressive symptoms and compositional changes in serum LDL particles in a sample of 2,456 middle-aged Finnish men. Depressive symptoms were assessed with the 18-item Human Population Laboratory Depression Scale, and the study population was divided into two groups (elevated depressive symptoms, n = 269; non-depressed, n = 2,187). The levels of serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides (TG), and ApoB were determined. The LDL-C/ApoB ratio, a marker of compositional changes in LDL particle size, was calculated. The group with elevated depressive symptoms had lowered levels of serum TC (P = 0.028) and LDL-C (P = 0.008). No differences were observed in the LDL-C/ApoB ratio. The likelihood for belonging to the group with elevated depressive symptoms increased 10% for each 0.5 mmol/l decrease in the levels of TC (P = 0.002) or LDL-C (P = 0.001) in regression models adjusted for age, examination years, marital and socioeconomic status, energy expenditure, body mass index, CVD history, alcohol consumption, smoking, and the use of lipid-lowering, antidepressant and antipsychotic medications. Our findings suggest that greater small-particle LDL levels are not associated with depression, and are thus unlikely to underlie the association between cardiovascular risk and depression.
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Abbreviations
- ApoB:
-
Apolipoprotein B
- BMI:
-
Body mass index
- CVD:
-
Cardiovascular disease
- CES-D:
-
Center for Epidemiological Studies Depression Scale
- CI:
-
Confidence interval
- HDL-C:
-
High-density lipoprotein cholesterol
- HPL:
-
Human Population Laboratory
- LDL-C:
-
Low-density lipoprotein cholesterol
- OR:
-
Odds ratio
- TC:
-
Total cholesterol
- TG:
-
Triglycerides
References
Joynt KE, Whellan DJ, O’Connor CM. Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry. 2003;54:248–61.
Partonen T, Haukka J, Virtamo J, Taylor PR, Lönnqvist J. Association of low serum total cholesterol with major depression and suicide. Br J Psychiatry. 1999;175:259–62.
Äijänseppä S, Kivinen P, Helkala EL, Kivelä SL, Tuomilehto J, Nissinen A. Serum cholesterol and depressive symptoms in elderly Finnish men. Int J Geriatr Psychiatry. 2002;17:629–34.
Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ, et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Québec Cardiovascular Study. Circulation. 1997;95:69–75.
Shin JY, Suls J, Martin R. Are cholesterol and depression inversely related? A meta-analysis of the association between two cardiac risk factors. Ann Behav Med. 2008;36:33–43.
Lindberg G, Larsson G, Setterlind S, Råstam L. Serum lipids and mood in working men and women in Sweden. J Epidemiol Community Health. 1994;48:360–3.
Nakao M, Yano E. Relationship between major depression and high serum cholesterol in Japanese men. Tohoku J Exp Med. 2004;204:273–87.
Huang TL. Serum lipid profiles in major depression with clinical subtypes, suicide attempts and episodes. J Affect Disord. 2005;86:75–9.
Salonen JT. Is there a continuing need for longitudinal epidemiological research? The Kuopio ischaemic heart disease risk factor study. Ann Clin Res. 1988;20:46–50.
Kaplan GA, Roberts RE, Camacho TC, Coyne JC. Psychosocial predictors of depression. Prospective evidence from the human population laboratory studies. Am J Epidemiol. 1987;125:206–20.
Roberts RE. Prevalence of depressive symptoms among Mexican Americans. J Nerv Ment Dis. 1981;169:213–9.
Roberts RE, O’Keefe SJ. Sex differences in depression reexamined. J Health Soc Behav. 1981;22:394–400.
Tolmunen T, Hintikka J, Voutilainen S, Ruusunen A, Alfthan G, Nyyssönen K, et al. Association between depressive symptoms and serum concentrations of homocysteine in men: a population study. Am J Clin Nutr. 2004;80:1574–8.
Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27:645–58.
Sorlie PD, Cooper L, Schreiner PJ, Rosamond W, Szklo M. Repeatability and validity of the Rose questionnaire for angina pectoris in the atherosclerosis risk in communities study. J Clin Epidemiol. 1996;49:719–25.
Wilson TW, Kaplan GA, Kauhanen J, Cohen RD, Wu M, Salonen R, et al. Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio ischemic heart disease risk factor study. Am J Epidemiol. 1993;137:292–300.
Lynch JW, Kaplan GA, Cohen RD, Kauhanen J, Wilson TW, Smith NL, et al. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet. 1994;343:524–7.
Lynch J, Kaplan GA, Salonen R, Cohen RD, Salonen JT. Socioeconomic status and carotid atherosclerosis. Circulation. 1995;92:1786–92.
Kauhanen J, Julkunen J, Salonen JT. Coping with inner feelings and stress: heavy alcohol use in the context of alexithymia. Behav Med. 1992;18:121–6.
Salonen JT, Lakka TA. Assessment of physical activity in population studies–validity and consistency of the methods in the Kuopio Ischemic Heart Study. Scand J Sports Med. 1987;9:89–95.
Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25:71–80.
Salonen R, Seppänen K, Rauramaa R, Salonen JT. Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland. Arteriosclerosis. 1988;8:788–92.
McNamara JR, Campos H, Ordovas JM, Peterson J, Wilson PW, Schaefer EJ. Effect of gender, age, and lipid status on low density lipoprotein subfraction distribution. Results from the Framingham Offspring Study. Arteriosclerosis. 1987;7:483–90.
Avogaro P, Beittolo BJ, Cuzzolato G, Quinci GB, Belussi F. Plasma level of lipoprotein A-1 and apolipoprotein B in human atherosclerosis. Artery. 1978;4:385–94.
Olusi SO, Fido AA. Serum lipid concentrations in patients with major depressive disorder. Biol Psychiatry. 1996;40:1128–31.
Lehto SM, Hintikka J, Niskanen L, Tolmunen T, Koivumaa-Honkanen H, Honkalampi K, et al. Low HDL cholesterol associates with major depression in a sample with a 7-year history of depressive symptoms. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1557–61.
Lindeman S, Hämäläinen J, Isometsä E, Kaprio J, Poikolainen K, Heikkinen M, et al. The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults. Acta Psychiatr Scand. 2000;102:178–84.
Engelberg H. Low serum cholesterol and suicide. Lancet. 1992;339:727–9.
Terao T, Nakamura J, Yoshimura R, Ohmori O, Takahashi N, Kojima H, et al. Relationship between serum cholesterol levels and meta-chlorophenylpiperazine-induced cortisol responses in healthy men and women. Psychiatry Res. 2000;96:167–73.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
Acknowledgments
SML was supported by Kuopio University Hospital EVO funding and research grants from the Foundation for Psychiatric Research and Finnish Medical Foundation. The authors would like to thank the personnel of the Research Institute of Public Health for their valuable contribution to this study.
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Lehto, S.M., Ruusunen, A., Niskanen, L. et al. Elevated depressive symptoms and compositional changes in LDL particles in middle-aged men. Eur J Epidemiol 25, 403–409 (2010). https://doi.org/10.1007/s10654-010-9457-1
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DOI: https://doi.org/10.1007/s10654-010-9457-1