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

• Published in: Diabetologia 2010-08, Vol.53 (8), p.1581-1589
• Main Authors: Rubin, R. R, Gaussoin, S. A, Peyrot, M, DiLillo, V, Miller, K, Wadden, T. A, West, D. S, Wing, R. R, Knowler, W. C
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Ankle Brachial Index; Antidepressant medication; Antidepressive Agents - therapeutic use; Biological and medical sciences; Blood Glucose; Cardiovascular Diseases - etiology; Chi-Square Distribution; CVD risk; Depression; Depression - diagnosis; Depression - drug therapy; Depression symptoms; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exercise; Female; Human Physiology; Humans; Insulin Resistance; Internal Medicine; Look AHEAD trial; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mood disorders; Obesity - complications; Patient Selection; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Regression Analysis; Risk Factors; Weight Loss
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-010-1765-1

Aims/hypothesis To determine the associations of baseline depression symptoms and use of antidepressant medicines (ADMs) with baseline cardiovascular disease (CVD) risk factors in Look AHEAD (Action for Health in Diabetes) trial participants. Methods Look AHEAD participants (n = 5,145; age 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m²) were assessed for CVD risk factors (elevated HbA₁c or insulin use, elevated BP or antihypertensive use, elevated lipid levels or lipid-lowering medication, current smoking, BMI ≥30 kg/m², lower peak exercise capacity assessed as metabolic equivalents [METs], and ankle-brachial index 1.3). Participants also completed the Beck Depression Inventory (BDI) and reported their use of ADMs. Results Of the participants, 14.7% had BDI scores ≥11, consistent with mild-moderate depression, and 16.5% took ADMs; 4.4% had both depression markers (i.e. elevated symptom scores and took ADMs). In logistic regression analyses of CVD risk (elevated risk factor or use of medication to control the risk factor), controlled for demographic factors, continuous BDI scores and ADM use were each independently associated with elevated BP (or medication), current smoking, BMI ≥30 kg/m² and lower MET values. ADM use was also associated with elevated serum lipids or use of lipid-lowering medication. Conclusions/interpretation Among Look AHEAD participants, depression symptoms or ADM use on entry to the study were each independently associated with a wide range of CVD risk factors. Future research should assess the temporal dynamics of the relationships of depression symptoms and ADM use with CVD risk factors. Trial registration Clinicaltrials.gov NCT00017953 Funding This study is funded by the National Institutes of Health with additional support from the Centers for Disease Control and Prevention.