This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (38)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Cardiovascular System  • Cardiovascular Disease/ Myocardial Infarction  • Depression  • Alert me on articles by topic

The Rotterdam Study

Henning Tiemeier, MD, PhD; Wim van Dijck, MSc; Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, PhD; Theo Stijnen, PhD; Monique M. B. Breteler, MD, PhD

Arch Gen Psychiatry. 2004;61:369-376.

Context  Depression in late life has been associated with vascular abnormalities. Several studies have demonstrated that persons with brain infarcts are more likely to have depressive disorders. Furthermore, depression is related to the subsequent development of ischemic heart disease.

Objective  To investigate the relationship between atherosclerosis at different locations and depression in the general population.

Design  Cross-sectional population-based study.

Setting  The Rotterdam Study, a population-based cohort study.

Participants  In 4019 men and women 60 years and older, we assessed atherosclerosis at different locations, including common carotid intima-media thickness, plaques in the carotid arteries, the ankle-brachial blood pressure index, and aortic atherosclerosis. An overall measure of extracoronary atherosclerosis was obtained in 3747 persons by computing the principal component of these extracoronary atherosclerosis measures. In a subgroup of 1986 persons, we additionally measured coronary calcifications.

Main Outcome Measure  All subjects were screened for depressive symptoms. Screen-positive subjects had a psychiatric interview to diagnose depressive disorder.

Results  More severe extracoronary atherosclerosis was associated with a higher prevalence of depressive disorders. For every 1–standard deviation increase, the prevalence increased by 30%. Furthermore, we found a strong relationship of severe coronary and aortic calcifications with depressive disorders (odds ratio, 3.89; 95% confidence interval, 1.55-9.77; and odds ratio, 2.00; 95% confidence interval, 1.02-3.96, respectively).

Conclusions  Atherosclerosis and depression are associated in the elderly. This finding is compatible with the vascular depression hypothesis. However, the cross-sectional nature of the study does not allow causal inferences. In particular, earlier depressive episodes may have contributed to the development of atherosclerosis.

From the Departments of Epidemiology and Biostatistics (Drs Tiemeier, Hofman, Witteman, Stijnen, and Breteler and Mr van Dijck) and Child and Adolescent Psychiatry (Dr Tiemeier), Erasmus Medical Center, Rotterdam, the Netherlands.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiac Disease, Depressive Symptoms, and Incident Stroke in an Elderly Population
Wouts et al.
Arch Gen Psychiatry 2008;65:596-602.
ABSTRACT | FULL TEXT  

Association of Cardiovascular Risk Factors and Disease With Depression in Later Life
Almeida et al.
AJGP 2007;15:506-513.
ABSTRACT | FULL TEXT  

Negative Emotions and 3-Year Progression of Subclinical Atherosclerosis
Stewart et al.
Arch Gen Psychiatry 2007;64:225-233.
ABSTRACT | FULL TEXT  

Cerebral emboli and depressive symptoms in dementia
Purandare et al.
Br. J. Psychiatry 2006;189:260-263.
ABSTRACT | FULL TEXT  

Psychosocial factors and coronary calcium in adults without clinical cardiovascular disease.
Diez Roux et al.
ANN INTERN MED 2006;144:822-831.
ABSTRACT | FULL TEXT  

Lessons Learned From International Comparative Crosscultural Studies on Dementia.
Hendrie
AJGP 2006;14:480-488.
ABSTRACT | FULL TEXT  

Depression in Older Age Is a Risk Factor for First Ischemic Cardiac Events.
Bremmer et al.
AJGP 2006;14:523-530.
ABSTRACT | FULL TEXT  

Depressive Psychosis: Clinical Usefulness of MR Spectroscopy Data in Predicting Prognosis
Kado et al.
Radiology 2006;238:248-255.
ABSTRACT | FULL TEXT  

Cardiovascular Risk Factors May Moderate Pharmacological Treatment Effects in Major Depressive Disorder
Iosifescu et al.
Psychosom. Med. 2005;67:703-706.
ABSTRACT | FULL TEXT  

Generalized atherosclerosis, cognitive decline, and depressive symptoms in old age
Vinkers et al.
Neurology 2005;65:107-112.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Carotid Artery Intima-Media Thickness in Young Adults: The Cardiovascular Risk in Young Finns Study
Elovainio et al.
Psychosom. Med. 2005;67:561-567.
ABSTRACT | FULL TEXT  

Coronary and Aortic Calcification in Women With a History of Major Depression
Agatisa et al.
Arch Intern Med 2005;165:1229-1236.
ABSTRACT | FULL TEXT  

Cerebrovascular Disease and Late-Life Depression
Kales et al.
AJGP 2005;13:88-98.
ABSTRACT | FULL TEXT