Depressive symptom clusters differentially predict cardiovascular hospitalization in people with Type 2 diabetes

G.M. Nefs, V.J.M. Pop, J. Denollet, F. Pouwer

Research output: Contribution to journalArticleScientificpeer-review

11 Citations (Scopus)


Depression has been associated with the development of cardiovascular disease in people with type 2 diabetes.
We examined whether symptoms related to the 2 core features of depression—dysphoria and anhedonia—and anxiety were differentially associated with cardiovascular hospitalization and whether there were symptom-specific mechanisms (alcohol, smoking, physical activity, body mass index, glucose, cholesterol, and blood pressure) in play.
A total of 1465 people in Dutch primary care completed the Edinburgh Depression Scale in 2005 and were followed up until first cardiovascular hospitalization during follow-up (event) or December 31, 2010 (study end). Cox regression analyses examined (1) differences in time to hospitalization for a cardiovascular event between people with a low vs a high baseline dysphoria/anhedonia/anxiety score (adjusting for demographic and clinical confounders) and (2) mediating mechanisms.
A total of 191 people were hospitalized for a cardiovascular event. In univariable analysis, dysphoria predicted a shorter time to cardiovascular hospitalization (hazard ratio = 1.49, 95% CI: 1.02–2.17). After adjustment for confounders, neither dysphoria (hazard ratio = 1.55, 95% CI: 0.91–2.64) nor anhedonia (hazard ratio = 0.83, 95% CI: 0.47–1.48) was significantly associated with time to cardiovascular hospitalization. Anxiety was associated with a longer time to cardiovascular hospitalization (adjusted hazard ratio = 0.49, 95% CI: 0.27–0.89). However, none of the selected factors qualified as a mediator for the (adjusted) association between anxiety and time to cardiovascular hospitalization.
Dysphoria was associated with a shorter time to cardiovascular hospitalization in unadjusted analyses only, whereas anxiety predicted later hospitalization after confounder adjustment. Anhedonia did not show a significant association. Mechanistic pathways remain unclear.
Original languageEnglish
Pages (from-to)662–673
Issue number6
Publication statusPublished - 18 Jun 2015


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