Four-year analysis of cardiovascular disease risk factors, depression symptoms, and antidepressant medicineuse in the lookahead (action for health in diabetes) clinical trial of weight loss in diabetes

Richard R. Rubin, Mark Peyrot, Sarah A. Gaussoin, Mark A. Espeland, Don Williamson, Lucy F. Faulconbridge, Thomas A. Wadden, Linda Ewing, Monika Safford, Gina Evans-Hudnall, Rena R. Wing, William C. Knowler

    Research output: Contribution to journalArticle

    Abstract

    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, HbA 1c > 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.

    Original languageEnglish (US)
    Pages (from-to)1088-1094
    Number of pages7
    JournalDiabetes care
    Volume36
    Issue number5
    DOIs
    StatePublished - May 2013

    ASJC Scopus subject areas

    • Internal Medicine
    • Endocrinology, Diabetes and Metabolism
    • Advanced and Specialized Nursing

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    Rubin, R. R., Peyrot, M., Gaussoin, S. A., Espeland, M. A., Williamson, D., Faulconbridge, L. F., Wadden, T. A., Ewing, L., Safford, M., Evans-Hudnall, G., Wing, R. R., & Knowler, W. C. (2013). Four-year analysis of cardiovascular disease risk factors, depression symptoms, and antidepressant medicineuse in the lookahead (action for health in diabetes) clinical trial of weight loss in diabetes. Diabetes care, 36(5), 1088-1094. https://doi.org/10.2337/dc12-1871