Association of 20-year longitudinal depressive symptoms with left ventricular geometry outcomes in the Coronary Artery Risk Development in Young Adults study: a role for androgens?

OBJECTIVE: Depression is a risk factor for coronary heart disease (CHD) and left ventricular hypertrophy (LVH) is a potent predictor of CHD events. Whether depression is associated with LVH has received limited investigation. This study assessed cross-sectional and 20-year longitudinal associations of depressive symptoms with LVH outcomes after accounting for important known confounders.

METHODS: From 5,115 participants enrolled in 1985-86 in the Coronary Artery Risk Development in Young Adults Study, 2,533 had serial measures of depressive symptoms and subsequent echocardiography to measure normal LV geometry, concentric remodeling, and LVH. The primary exposure variable was trajectories of the Center for Epidemiologic Studies Depression (CES-D) Scale score from 1990-91 to 2010-11. Multivariable polytomous logistic regression was used to assess associations of trajectories with a composite LV geometry outcome created using echocardiogram data measured in 2010-11 and 2015-16. Sex-specific conflicting results led to exploratory models that examined potential importance of testosterone and sex hormone binding globulin (SHBG).

RESULTS: Overall CES-D and Somatic subscale trajectories had significant associations with LVH for females only. Odds ratios for the subthreshold (mean CES-D ≈ 14) and stable (mean CES-D ≈ 19) groups were 1.49 (95% CI: 1.05-2.13) and 1.88 (95% CI: 1.16-3.04), respectively. For females, SHBG was inversely associated with LVH and for males, bioavailable testosterone was positively associated with concentric geometry.

CONCLUSIONS: Findings from cross-sectional and longitudinal regression models for females, but not males, and particularly for Somatic subscale trajectories suggested a plausible link among depression, androgens, and LVH. The role of androgens to the depression - LVH relation requires additional investigation in future studies.