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 Table of Contents  
DR. A. K. KALA AWARD PAPER
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 5-9

A study of cardiovascular risk among depressed obese patients


Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission12-May-2018
Date of Acceptance10-Aug-2019
Date of Web Publication7-Oct-2020

Correspondence Address:
Mohd Wasim
Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_19_18

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  Abstract 


Background: Both depression and obesity are widespread problems with major public health implications. Depression and obesity are both associated with an increased risk of cardiovascular disease (CVD) and with marked impairments in the quality of life. Aim and Objective: The aim of the study is to assess the CVD risk and cardiovascular risk factors among depressed obese individuals. Materials and Methods: Fifty patients of depression whose body mass index (BMI) >30 kg/m2 and diagnosed with ICD-10 criteria of depression were selected as study group and 30 healthy obese of BMI >30 kg/m2 without depression were selected as the control group for the study. The participants were divided into two groups: obese patients with depression and healthy obese individuals without depression. Fasting venous blood sample was collected under aseptic condition to estimate fasting blood sugar, total cholesterol, and high - density lipoprotein cholesterol. Using standard mercury manometer at least two readings at 5 - min intervals, were taken to measure the blood pressure (BP) in the supine position. Both the groups were subjected to specially designed pro forma which included personal and sociodemographic details and Framingham risk assessment tool for assessing cardiovascular risk. The cardiovascular risk was assessed and compared using Framingham risk score assessment tool. Results and Conclusion: Mean age of depressed obese was 46.44 ± 10.44 years and healthy obese had 47.33 ± 10.53. Mean BMI of study group was 32.82 ± 2.53 and healthy obese had 31.76 ± 1.66. BMI was significantly associated with depression. Presence of depression in obese patients increases the chances of CVD risk. Presence of smoking, hypertension, and high cholesterol in patients with depression, increase the risk of CVD, which can be modified by healthy diet, regular exercise, and BP management with periodic blood investigation and regular medication.

Keywords: Cardiovascular risk, depression, obesity


How to cite this article:
Singh C, Wasim M, Solanki R K. A study of cardiovascular risk among depressed obese patients. J Mental Health Hum Behav 2020;25:5-9

How to cite this URL:
Singh C, Wasim M, Solanki R K. A study of cardiovascular risk among depressed obese patients. J Mental Health Hum Behav [serial online] 2020 [cited 2020 Dec 3];25:5-9. Available from: https://www.jmhhb.org/text.asp?2020/25/1/5/297412




  Introduction Top


Both depression and obesity are widespread problems with major public health implications.[1],[2] Depression and obesity are both associated with an increased risk of cardiovascular disease (CVD)[3],[4],[5] and with marked impairments in the quality of life.[6],[7] Obesity is a major public health concern that is widely prevalent across all age groups and cultures. The prevalence of obesity varies across the world. Indian studies showed 15%–37% prevalence of overweight/obesity among the adult population aged between 20 and 60 years.[8],[9],[10] In general, obesity is defined on the basis of body mass index (BMI). Individuals with a BMI ≥30 kg/m2 are considered obese.[11] The association of obesity and abnormal lipid levels with physical illnesses such as hypertension (HTN), diabetes mellitus (DM), and CVD has been well documented.[12],[13] Previous studies reported a positive association of obesity with mood disorders (depression), anxiety disorders, eating disorders, and personality disorders,[14],[15] which in turn may contribute to the development of obesity itself. This bidirectional association of obesity and psychiatric disorders was observed in a few studies.[16],[17] Depression is an independent risk factor for the development of CVDs. Depression also raises the risk for further diseases, such as DM or obesity, which themselves are associated with higher cardiovascular risk.[18]

The equation of the Framingham 10-year risk for CVD, derived from the Framingham heart study, has been validated and widely used in different populations to predict the 10-year risk of CVD, including angina, myocardial infarction (MI), stroke, transient ischemic attack and peripheral artery disease.[19]

Hence, this study was carried out to assess the cardiovascular risk and cardiovascular risk variables (age, smoking, DM, HTN, total cholesterol, high - density lipoprotein (HDL) cholesterol, and systolic blood pressure (SBP) among depressed obese patients and non-depressed obese individuals. The study was carried out to assess cardiovascular risk and cardiovascular risk factors among depressed obese individuals.

Selection criteria

Inclusion criteria for study group

  • Patient diagnosed with depression as per the criteria given in ICD-10
  • Age 30–60 belonging to either sex
  • Patients with BMI >30 kg/m2 calculated by Quetelet Index (kg/m2).


Inclusion criteria for healthy group

  • Healthy obese individuals who had no past or present history of physical or psychiatric illness.


Exclusion criteria

  • Participants having a prior history of CVD including MI, stroke, and any complication of DM.



  Materials and Methods Top


A cross-sectional study was carried out in the Department of Psychiatry, SMS medical college, Jaipur, India, after taking permission from the Ethical Committee of Institution. Informed consent was obtained from all the participants participating in the study. Fifty patients of depression whose BMI >30 kg/m2 and diagnosed with ICD-10 criteria of depression were selected as study group and thirty number of healthy obese of BMI >30 kg/m2 without depression were selected as the control group for study, matched on sociodemographic variables (direct standardization) from community, patient's relative, and hospital staff.

The participants were divided into two groups, obese patients with depression and healthy obese individuals without depression. Fasting venous blood sample was collected under aseptic condition to estimate fasting blood sugar, total cholesterol, and HDL cholesterol. Using standard mercury manometer at least two readings at 5 - min intervals, were taken to measure the BP in the supine position. If BP was found to be high (≥140/90), then a third reading after 30 min was obtained; the lowest of these readings was taken. All the patients' personal and sociodemographic details were recorded and cardiovascular risk was assessed and compared using Framingham risk score assessment tool.

Ten years cardiovascular disease risk calculation[19],[20],[21]

Framingham risk score provides an estimate of the chances that a person will develop CVD over a specified period, usually 10-year. The score is estimated on the basis of age, gender, total cholesterol, HDL cholesterol, systolic arterial pressure, HTN, DM, and smoking habit. On the basis of the Framingham risk score, CVD risk is estimated in terms of percentage. Higher percentage score indicates higher risk and the percentage scores are categorized arbitrarily into as low risk (10%) and high risk (>10%).

Statistical analysis

Statistical analysis was done using IBM Statistical Package for Window, version 23 (IBM coperation, Chicago). Frequencies with percentages were calculated for nominal and ordinal variables and mean and standard deviation (SD) were calculated for continuous variables. Group differences were analyzed with the help of frequency distribution, Chi-square test, and t-test for comparisons.


  Results Top


Mean age of depressed obese was 46.44 ± 10.44 years and healthy obese had 47.33 ± 10.53. Mean BMI of study group was 32.82 ± 2.53 and healthy obese had 31.76 ± 1.66 (range 30–40 kg/m2). Age was not statistically significant (t = 0.358, df = 78, P = 0.72), but BMI in both groups was statistically significant (t = 2.023, df = 78, P = 0.047) [Table 1].
Table 1: Mean and standard deviation of age and body mass index of studied groups

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[Table 2] shows sociodemographic variables of study groups, two-third were female (64% in study group and 66.66% in control group). Fifty-four percent depressed obese and 63.33% healthy obese are from the urban locality. Nearly 90% are married in both groups. Healthy group was matched on sociodemographic variables with the study group; therefore, no differences were found in sociodemographic variables statistically in both groups.
Table 2: Sociodemographic variable of studied group

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[Table 3] shows that 36% depressed obese and 26.66% healthy obese have very high/high CVD risk score. These values were not statistically significant (χ2 = 0.745, df = 1, P = 0.388).
Table 3: Framingham score (cardiovascular disease risk in 10 years) of studied group

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[Table 4] shows the prevalence of various CVD risk factors in both groups. The most commonly present CVD risk factor was high total cholesterol, age followed by, HDL cholesterol, HTN, smoking, DM, and high SBP. Among various CVD factors smoking (χ2 = 5.569, df = 1, P = 0.018) and HTN (χ2 = 7.172, df = 1, P = 0.007) had statistically significant value.
Table 4: Cardiovascular disease risk factors of the studied group

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  Discussion Top


In this study, mean BMI of study group was 32.82 (SD ± 2.53) and healthy obese had 31.76 (SD ± 1.66) (range 30–40 kg/m2). The difference in BMI in both the groups was significant. BMI was significantly associated with depression. In this study, the most commonly present CVD risk factors were age, high total cholesterol, HDL cholesterol, HTN, smoking, DM, and high SBP. Among various CVD risk factors, smoking and HTN were statistically significant.

Studies have reported a strong association of CVD risk factors with both obesity and depression and associated with numerous health complications, including HTN, coronary heart disease, and increased mortality.[22] Psychological stress experienced by people suffering from major depressive disorder (MDD) can also cause deregulation in the sympathetic nervous system and hypothalamic–pituitary–adrenal (HPA) axis.[23],[24] This, in turn, has a number of deleterious downstream effects, including the development of HTN, left ventricular hypertrophy,[25] coronary vasoconstriction, endothelial dysfunction,[26],[27],[28] platelet activation, and the production of pro-inflammatory cytokines.[29],[30] The potential consequence of this is an elevated risk in ventricular arrhythmias[31] and MI.[32]

It is well established that there are number of behavioral and lifestyle factors, which are present in MDD patients that can increase the chance of developing CHD.[33] These include increased rates of smoking, alcohol intake, physical inactivity, and obesity.[34] Furthermore, some antidepressant may also increase cardiovascular risk. The possible findings of excessive smoking habits in obese patients with depression could be its use to elevate mood. Currently, there are several hypotheses that have been proposed to explain the high rates of smoking in people with depression and anxiety. The self-medication hypothesis postulates that individuals turn to smoking to alleviate their symptoms.[35],[36],[37] The effect of smoking on depression and anxiety can be explained by the neurobiochemical response mechanism of nicotine and monoamine oxidase. First, smoking increases the amount of nicotine in the blood. Then, nicotine promotes corticosteroid, a hormone in the body, by stimulating the HPA axis and increases the manifestation of messenger RNA related to steroids in the cells of the cerebral amygdala, which is in charge of emotions and feelings.[38] Sedentary lifestyles are responsible for obesity and HTN.

On a behavioral level, depression is often associated with an unhealthy lifestyle such as smoking and physical inactivity. In addition, depressed patients also have more difficulties to implement recommended behavioral change.[18] The major depression is associated with a significantly higher number of cardiovascular risk factors in the presence or absence of heart disease.[39] It has also been found that the increased cardiovascular risk among individuals with depression is multifactorial and requires several strategies toward cardiovascular risk reduction, tobacco cessation, and for increasing physical activity in people with depression.[40]

Limitations

The present study was a cross-sectional study having small sample size. The effect of lifestyle factors, physical activity levels, and dietary factors were not assessed which can also affect CVD risk. The association between severity of depression and CVD risk was also not evaluated.


  Conclusion Top


BMI is significantly associated with depression. Presence of depression in obese patients increases chance of CVD risk. Presence of smoking, HTN, and high cholesterol in patients with depression, increase the risk of CVD.

General recommendations

There are following recommendations after evaluating the results of our study:

  1. The assessment of patients of depression should definitely include significant risk factors such as smoking, HTN, and high cholesterol which can further be assessed for cardiovascular risk.
  2. The patients of depression with significant risk factors smoking, HTN, and high cholesterol should be advised as:


    1. Quit smoking, advise nicotine substitutes if needed
    2. Controlling BP by regular morning exercise, dietary modifications (salt <5 mg/day), and antihypertensive medicine, if required
    3. The medication to reduce cholesterol with dietary modifications, e.g., increase roughage and fiber contents in diet.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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