Four-Year Analysis of Cardiovascular Disease Risk Factors, Depression Symptoms, and Antidepressant Medicine Use in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Diabetes
- Richard R. Rubin, PHD1,2,
- Mark Peyrot, PHD3⇑,
- Sarah A. Gaussoin, MS4,
- Mark A. Espeland, PHD4,
- Don Williamson, PHD5,
- Lucy F. Faulconbridge, PHD6,
- Thomas A. Wadden, PHD6,
- Linda Ewing, PHD7,
- Monika Safford, MD8,
- Gina Evans-Hudnall, PHD9,10,
- Rena R. Wing, PHD11,
- William C. Knowler, MD12,
- the Look AHEAD Research Group*
- 1Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- 2Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- 3Department of Sociology, Loyola University Maryland, Baltimore, Maryland
- 4Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- 5Division of Clinical Obesity and Metabolism, Pennington Biomedical Research Center, Baton Rouge, Louisiana
- 6Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- 7Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- 8Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- 9Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- 10Department of Medicine, Baylor College of Medicine, Houston, Texas
- 11Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
- 12Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
- Corresponding author: Mark Peyrot,
OBJECTIVE To study the association of depressive symptoms or antidepressant medicine (ADM) use with subsequent cardiovascular disease (CVD) risk factor status in the Look AHEAD (Action for Health in Diabetes) trial of weight loss in type 2 diabetes.
RESEARCH DESIGN AND METHODS Participants (n = 5,145; age [mean ± SD] 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m2) in two study arms (intensive lifestyle [ILI], diabetes support and education [DSE]) completed the Beck Depression Inventory (BDI), reported ADM use, and were assessed for CVD risk factors at baseline and annually for 4 years. Risk factor–positive status was defined as current smoking, obesity, HbA1c >7.0% or insulin use, and blood pressure or cholesterol not at levels recommended by expert consensus panel or medicine to achieve recommended levels. Generalized estimating equations assessed within-study arm relationships of elevated BDI score (≥11) or ADM use with subsequent year CVD risk status, controlled for demographic variables, CVD history, diabetes duration, and prior CVD risk status.
RESULTS Prior year elevated BDI was associated with subsequent CVD risk factor–positive status for the DSE arm (A1C [odds ratio 1.30 (95% CI 1.09–1.56)]; total cholesterol [0.80 (0.65–1.00)]; i.e., protective from high total cholesterol) and the ILI arm (HDL [1.40 (1.12–1.75)], triglyceride [1.28 (1.00–1.64)]). Prior year ADM use predicted subsequent elevated CVD risk status for the DSE arm (HDL [1.24 (1.03–1.50)], total cholesterol [1.28 (1.05–1.57)], current smoking [1.73 (1.04–2.88)]) and for the ILI arm (A1C [1.25 (1.08–1.46)], HDL [1.32 (1.11–1.58)], triglycerides [1.75 (1.43–2.14)], systolic blood pressure [1.39 (1.11–1.74)], and obesity [1.46 (1.22–2.18)]).
CONCLUSIONS Aggressive monitoring of CVD risk in diabetic patients with depressive symptoms or who are treated with ADM may be warranted.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-1871/-/DC1.
↵* The Look AHEAD Research Group at baseline is detailed in the Supplementary Data.
- Received September 12, 2012.
- Accepted October 18, 2012.
- © 2013 by the American Diabetes Association.
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