Cardiac risk factors in patients with diabetes mellitus and major depression

J Gen Intern Med. 2004 Dec;19(12):1192-9. doi: 10.1111/j.1525-1497.2004.30405.x.


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) > or = 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 > or = 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Albuminuria / complications
  • Body Mass Index
  • Cardiovascular Diseases / etiology*
  • Cholesterol, LDL / blood
  • Depressive Disorder, Major / complications*
  • Diabetes Complications*
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hypertension / complications
  • Life Style
  • Male
  • Middle Aged
  • Risk Factors
  • Self Care
  • Smoking / adverse effects
  • Surveys and Questionnaires
  • Triglycerides / blood


  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • Triglycerides