Individuals with depression have twice the risk of developing CVD. Depression increase the risk for cardiac mortality 2-4 times. Background socio economic and life style factors are linked to this increased risk. Reduced uptake of screening, not receiving good quality physical care, poor compliance with treatments, medication effects, smoking, inactivity , depression associated changes in physiology all contribute to this.
It is important to identify risk factors in routine care of depression. The concept of metabolic syndrome (central obesity, high blood pressure, low levels of high density lipoprotein cholesterol (HDL-C), elevated triglycerides and hyperglycemia ) help clinicians to focus on risk factors and address them appropriately.
How common is Metabolic syndrome among individuals with depression?
D. Vancampfort et al report the results of a meta analysis on this question. All studies (case–control studies, prospective cohort studies, cross-sectional studies and comparisons of study populations with age standardisation ) where depression was diagnosed using DSM or ICD criteria and Met S diagnosed according to existing criteria ( either WHO, IDF or ATP) were included.
18 studies met criteria with the total data set having 5531 individuals . Studies included both out patients and inpatients. Weighted mean prevalence of MetS was 30.5% (95% CI 26.3–35.1). Use of different MetS criteria did not make any significant difference. 40% of individuals with MDD had abdominal obesity. About 30% had abnormal HDL-C or triglycerides, and 20% had significant pre- diabetes (using the > 110 mg/dl fasting glucose threshold for hyperglycemia).
There was no significant difference between men and women
Age did not explain differences in prevalence estimates.
whether illness duration had a moderating effect was not investigated.
No relationship between antidepressant use and MetS prevalence was found but conclusions on this cannot be made with present data.
Use of antipsychotics was a significant moderator for increased prevalence of MetS.
Methodological heterogeneity across studies. (random-effects models used). Studies with less than 50 participants were excluded.
Conclusions: Odds for MetS are 1.5 times higher for persons with MDD compared with general population controls. Individuals with depression are at a high risk for Met S.
Comments: All patients diagnosed with depression should be monitored for met S.
Summary of the article:
Vancampfort D, Correll CU, Wampers M, Sienaert P, Mitchell AJ, De Herdt A, Probst M, Scheewe TW, De Hert M. Psychol Med. 2014. June.