Cardiac Risk Factors in Patients with Diabetes Mellitus and Major Depression


  • Wayne J. Katon MD,

    Corresponding authorSearch for more papers by this author
  • Elizabeth H.B. Lin MD, MPH,

  • Joan Russo PhD,

  • Michael Von Korff ScD,

  • Paul Ciechanowski MD, MPH,

  • Greg Simon MD, MPH,

  • Evette Ludman PhD,

  • Terry Bush PhD,

  • Bessie Young MD, MPH

  • Received from the Department of Psychiatry and Behavioral Sciences (WJK, JR, PC), University of Washington School of Medicine; Center for Health Studies (EL, MVK, GS, EL, TB), Group Health Cooperative; and Department of Medicine (BY), Veterans Administrative Hospital, University of Washington, Seattle, Wash.

Address correspondence and requests for reprints to Dr. Katon: Health Services, Research and Psychiatric Epidemiology, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific, Seattle, WA 98195-6560 (e-mail:


OBJECTIVE:  The prevalence of major depression is approximately 2-fold higher in patients with diabetes mellitus compared to medical controls. We explored the association of major depression with 8 cardiac risk factors in diabetic patients with and without evidence of cardiovascular disease (CVD).

DESIGN:  A mail survey questionnaire was administered to a population-based sample of 4,225 patients with diabetes to obtain data on depression status, diabetes self-care (diet, exercise, and smoking), diabetes history, and demographics. On the basis of automated data we measured diabetes complications, glycosylated hemoglobin, medical comorbidity, low-density lipid levels, triglyceride levels, diagnosis of hypertension, and evidence of microalbuminuria. Separate analyses were conducted for subgroups according to the presence or absence of CVD.

SETTING:  Nine primary care clinics of a nonprofit health maintenance organization.

MAIN RESULTS:  Patients with major depression and diabetes were 1.5- to 2-fold more likely to have 3 or more cardiovascular risk factors as patients with diabetes without depression (62.5% vs 38.4% in those without CVD, and 61.3% vs 45% in those with CVD). Patients with diabetes without CVD who met criteria for major depression were significantly more likely to be smokers, to have a body mass index (BMI) ≥ 30 kg/m2, to lead a more sedentary lifestyle, and to have HbA1c levels of >8.0% compared to nondepressed patients with diabetes without heart disease. Patients with major depression, diabetes, and evidence of heart disease were significantly more likely to have a BMI ≥ 30 kg/m2, a more sedentary lifestyle, and triglyceride levels > 400 mg/dl than nondepressed diabetic patients with evidence of heart disease.

CONCLUSIONS:  Patients with major depression and diabetes with or without evidence of heart disease have a higher number of CVD risk factors. Interventions aimed at decreasing these risk factors may need to address treatment for major depression in order to be effective.