Annals of Behavioral Medicine

, Volume 51, Issue 4, pp 620–628 | Cite as

Accumulation of Depressive Symptoms and Carotid Intima-Media Thickness: the Cardiovascular Risk in Young Finns Study

  • Liisa Keltikangas-Järvinen
  • Kateryna Savelieva
  • Kim Josefsson
  • Marko Elovainio
  • Laura Pulkki-Råback
  • Markus Juonala
  • Olli T. Raitakari
  • Mirka Hintsanen
Original Article



The association between depressive symptoms and subclinical atherosclerosis has been inconsistent.


We sought to replicate our previous study, which demonstrated a positive relation between depressive symptoms and subclinical atherosclerosis assessed with carotid intima-media thickness (IMT) in men, using a newer measurement of carotid IMT and a cumulative loading of depressive symptoms over three follow-ups.


The sample comprised 996 adults (352 men) aged 30 to 45 years in 2007 from a prospective population-based Finnish sample. The participants completed a modified version of Beck Depression Inventory in 1992, 1997, and 2001. Carotid IMT was assessed with ultrasound in 2001 and 2007. Cardiovascular risk factors (i.e., body mass index, systolic blood pressure, low-density lipoprotein cholesterol, and smoking) were measured in childhood (1980) and in adulthood (2007).


We found no association between the accumulative depression index and carotid IMT before or after controlling for the traditional risk factors (all p values ≥0.67). Depressive symptoms did not predict IMT progression over two time points and the highest level of carotid wall thickening. Imputed and non-imputed data sets provided similar results. Results remained the same when men and women were analyzed separately. Additional analyses revealed no significant interactions between depressive symptoms and cardiovascular risk factors (i.e., body mass index and systolic blood pressure) on carotid IMT (all p values >0.15).


The findings of this population-based study did not indicate any direct association between depressive symptoms and carotid IMT in asymptomatic, young adults.


Atherosclerosis Carotid intima-media thickness Depression Psychosomatic 

Supplementary material

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ESM 1(DOCX 37.2 kb)


  1. 1.
    Frasure-Smith N, Lesperance F. Depression and cardiac risk: Present status and future directions. Heart. 2010; 96: 173–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Hemingway H, Marmot M. Evidence based cardiology: Psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ. 1999; 318: 1460–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Khan FM, Kulaksizoglu B, Cilingiroglu M. Depression and coronary heart disease. Curr Atheroscler Rep. 2010;12: 105–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Rugulies R. Depression as a predictor for coronary heart disease. Am J Prev Med. 2002; 23: 51–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Celano CM, Huffman JC. Depression and cardiac disease. Cardiol Rev. 2011; 19: 130–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Cohen BE, Edmondson D, Kronish IM. State of the art review: Depression, stress, anxiety, and cardiovascular disease. Am J Hypertens. 2015; 28: 1295–302.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation. 2007; 115: 459–67.CrossRefPubMedGoogle Scholar
  8. 8.
    Mackinnon AD, Jerrard-Dunne P, Sitzer M, Buehler A, von Kegler S, Markus HS. Rates and determinants of site-specific progression of carotid artery intima-media thickness: The Carotid Atherosclerosis Progression Study. Stroke. 2004; 35: 2150–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Faramawi MF, Gustat J, Wildman RP, Rice J, Johnson E, Sherwin R. Relation between depressive symptoms and common carotid artery atherosclerosis in American persons ≥65 years of age. Am J Cardiol. 2007; 99: 1610–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Tiemeier H, van Dijck W, Hofman A, Witteman JCM, Stijnen T, Breteler MMB. Relationship between atherosclerosis and late-life depression. Arch Gen Psychiatry. 2004; 61: 369–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Haas DC, Davidson KW, Schwartz DJ, Rieckmann N, Roman MJ, Pickering TG, et al. Depressive symptoms are independently predictive of carotid atherosclerosis. Am J Cardiol. 2005; 95: 547–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Hamer M, Kivimäki M, Lahiri A, Marmot MG, Steptoe A. Persistent cognitive depressive symptoms are associated with coronary artery calcification. Atherosclerosis. 2010; 210: 209–13.Google Scholar
  13. 13.
    Ohira T, Diez Roux A V., Polak JF, Homma S, Iso H, Wasserman BA. Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness. Psychosom Med. 2012; 74: 517–25.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rice SC, Zonderman AB, Metter EJ, Najjar SS, Waldstein SR. Absence of relation between depressive symptoms and carotid intimal medial thickness in the Baltimore Longitudinal Study of Aging. Psychosom Med. 2009; 71: 70–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Whipple MO, Lewis TT, Sutton-Tyrrell K, Matthews KA, Barinas-Mitchell E, Powell LH, et al. Hopelessness, depressive symptoms, and carotid atherosclerosis in women: The Study of Women’s Health Across the Nation (SWAN) Heart Study. Stroke. 2009; 40: 3166–72.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Newson RS, Hek K, Luijendijk HJ, Hofman A, Witteman JCM, Tiemeier H. Atherosclerosis and incident depression in late life. Arch Gen Psychiatry. 2010; 67: 1144–1150.CrossRefPubMedGoogle Scholar
  17. 17.
    Beutel ME, Wiltink J, Kirschner Y, Sinning C, Espinola-Klein C, Wild PS, et al. History of depression but not current depression is associated with signs of atherosclerosis: Data from the Gutenberg Health Study. Psychol Med. 2014; 44: 919–25.CrossRefPubMedGoogle Scholar
  18. 18.
    Elovainio M, Keltikangas-Järvinen L, Kivimäki M, Pulkki L, Puttonen S, Heponiemi T, et al. Depressive symptoms and carotid artery intima-media thickness in young adults: The Cardiovascular Risk in Young Finns Study. Psychosom Med. 2005; 67: 561–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Bus BAA, Marijnissen RM, Holewijn S, Franke B, Purandare N, de Graaf J, et al. Depressive symptom clusters are differentially associated with atherosclerotic disease. Psychol Med. 2011; 41: 1419–28.CrossRefPubMedGoogle Scholar
  20. 20.
    Pizzi C, Costa GM, Santarella L, Flacco ME, Capasso L, Bert F, et al. Depression symptoms and the progression of carotid intima-media thickness: A 5-year follow-up study. Atherosclerosis. 2014; 233: 530–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Pizzi C, Manzoli L, Mancini S, Bedetti G, Fontana F, Costa GM. Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors. Atherosclerosis. 2010; 212: 292–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Kabir AA, Srinivasan SR, Sultana A, Chen W, Wei CY, Berenson GS. Association between depression and intima-media thickness of carotid bulb in asymptomatic young adults. Am J Med. 2009; 122: 1151.e1–1151.e8.CrossRefGoogle Scholar
  23. 23.
    Jones DJ, Bromberger JT, Sutton-Tyrrell K, Matthews KA. Lifetime history of depression and carotid atherosclerosis in middle-aged women. Arch Gen Psychiatry. 2003; 60: 153–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Raitakari OT, Juonala M, Ronnemaa T, Keltikangas-Järvinen L, Rasanen L, Pietikainen M, et al. Cohort profile: The Cardiovascular Risk in Young Finns Study. Int J Epidemiol. 2008; 37: 1220–6.Google Scholar
  25. 25.
    Beck AT, Steer RA. Manual for the revised Beck Depression Inventory. San Antonio, TX: Psychological corporation; 1987.Google Scholar
  26. 26.
    Katainen S. Temperament and Development: A Longitudinal Study of Temperament-Mothering Interaction and the Development of Temperament, Depressive Tendencies and Hostility [dissertation]. Helsinki: University of Helsinki; 1999.Google Scholar
  27. 27.
    Rosenström T, Jokela M, Puttonen S, Hintsanen M, Pulkki-Råback L, Viikari JS, et al. Pairwise measures of causal direction in the epidemiology of sleep problems and depression. Gilestro GF, ed. PLoS One. 2012; 7: e50841.Google Scholar
  28. 28.
    Rosenström T, Jokela M, Hintsanen M, Pulkki-Råback L, Hutri-Kähönen N, Keltikangas-Järvinen L. Longitudinal course of depressive symptoms in adulthood: Linear stochastic differential equation modeling. Psychol Med. 2013; 43: 933–44.CrossRefPubMedGoogle Scholar
  29. 29.
    Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood. JAMA. 2003; 290: 2277–83.CrossRefPubMedGoogle Scholar
  30. 30.
    Koskinen J, Kahonen M, Viikari JSA, Taittonen L, Laitinen T, Ronnemaa T, et al. Conventional cardiovascular risk factors and metabolic syndrome in predicting carotid intima-media thickness progression in young adults: The Cardiovascular Risk in Young Finns Study. Circulation. 2009; 120: 229–36.CrossRefPubMedGoogle Scholar
  31. 31.
    Flu W-J, van Kuijk J-P, Hoeks SE, Kuiper R, Schouten O, Goei D, et al. Intima media thickness of the common carotid artery in vascular surgery patients: A predictor of postoperative cardiovascular events. Am Heart J. 2009; 158: 202–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18: 499–502.PubMedGoogle Scholar
  33. 33.
    Royston P, White IR. Multiple imputation by chained equations (MICE): Implementation in Stata. J Stat Softw. 2011; 45: 1–20.CrossRefGoogle Scholar
  34. 34.
    Lee Y-H, Shin M-H, Choi J-S, Nam H-S, Jeong S-K, Park K-S, et al. Gender differences in the association between depressive symptoms and carotid atherosclerosis among middle-aged and older Koreans: The Namwon Study. J Korean Med Sci. 2014; 29: 1507–13.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Everson SA, Kaplan GA, Goldberg DE, Salonen R, Salonen JT. Hopelessness and 4-year progression of carotid atherosclerosis : The Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler Thromb Vasc Biol. 1997; 17: 1490–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Meijer A, Zuidersma M, de Jonge P. Depression as a non-causal variable risk marker in coronary heart disease. BMC Med. 2013; 11: 130.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Kop WJ, Gottdiener JS. The role of immune system parameters in the relationship between depression and coronary artery disease. Psychosom Med. 2005; 67: S37–41.CrossRefPubMedGoogle Scholar
  38. 38.
    Stetler C, Miller GE. Depression and hypothalamic-pituitary-adrenal activation: A quantitative summary of four decades of research. Psychosom Med. 2011; 73: 114–26.CrossRefPubMedGoogle Scholar
  39. 39.
    Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med. 2005; 67: S29–33.CrossRefPubMedGoogle Scholar
  40. 40.
    Bruce EC, Musselman DL. Depression, alterations in platelet function, and ischemic heart disease. Psychosom Med. 2005; 67: S34–36.CrossRefPubMedGoogle Scholar
  41. 41.
    Villareal DT, Miller BVI, Banks M, Fontana L, Sinacore DR, Klein S. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults. Am J Clin Nutr. 2006; 84: 1317–23.PubMedGoogle Scholar
  42. 42.
    Sutin AR, Terracciano A, Milaneschi Y, An Y, Ferrucci L, Zonderman AB. The trajectory of depressive symptoms across the adult life span. JAMA Psychiatry. 2013; 70: 803–811.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Stewart JC, Janicki DL, Muldoon MF, Sutton-Tyrrell K, Kamarck TW. Negative emotions and 3-year progression of subclinical atherosclerosis. Arch Gen Psychiatry. 2007; 64: 225–33.CrossRefPubMedGoogle Scholar
  44. 44.
    Bots ML, Hofman A, Grobbee DE. Increased common carotid intima-media thickness: Adaptive response or a reflection of aherosclerosis? Findings from the Rotterdam Study. Stroke. 1997; 28: 2442–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Folsom AR, Kronmal RA, Detrano RC, O’Leary DH, Bild DE, Bluemke DA, et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008; 168: 1333–1339.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2017

Authors and Affiliations

  • Liisa Keltikangas-Järvinen
    • 1
  • Kateryna Savelieva
    • 1
  • Kim Josefsson
    • 2
  • Marko Elovainio
    • 1
    • 2
  • Laura Pulkki-Råback
    • 3
    • 1
  • Markus Juonala
    • 4
    • 5
    • 6
  • Olli T. Raitakari
    • 7
    • 8
  • Mirka Hintsanen
    • 1
    • 9
  1. 1.Institute of Behavioural SciencesUniversity of HelsinkiHelsinkiFinland
  2. 2.National Institute for Health and WelfareHelsinkiFinland
  3. 3.Helsinki Collegium for Advanced StudiesUniversity of HelsinkiHelsinkiFinland
  4. 4.Department of MedicineUniversity of TurkuTurkuFinland
  5. 5.Division of MedicineTurku University HospitalTurkuFinland
  6. 6.Murdoch Childrens Research InstituteParkvilleAustralia
  7. 7.Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
  8. 8.Department of Clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland
  9. 9.Unit of Psychology, Faculty of EducationUniversity of OuluOuluFinland

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