Association of Mental Health Scores with Biomarkers of Cardiovascular Disease Among Overweight Adults: Findings from the PREDIMED-PLUS Trial Público
Ikkurthy, Niharika (Spring 2025)
Abstract
Background: Depression and cardiovascular disease are among the leading contributors to global disease burden, with emerging evidence suggesting associations between them. While existing studies have explored concurrent depression and cardiovascular disease, limited data is available on how depressive symptoms may influence the development of cardiovascular disease. This study examined the association between depressive symptoms, as measured by the Beck Depression Inventory (BDI), and cardiovascular biomarkers among overweight and obese older adults to determine if depression plays a role in developing heart disease.
Methods: Cross-sectional data from 536 participants in the PREDIMED-Plus trial, a Spanish lifestyle intervention study aimed at preventing cardiovascular disease, were analyzed. Participants aged 55–75 years with BMI ≥27 and <40 kg/m² and no history of cardiovascular disease were included. The primary exposure was depressive scores, measured by the Beck Depression Inventory. The outcomes included the cardiovascular biomarkers: high-sensitivity Troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), 3-nitrotyrosine, and serum carboxy-terminal propeptide of type I procollagen (PICP). Multivariate linear regression models were used to assess associations while adjusting for sociodemographic, clinical, and lifestyle factors.
Results: The mean (SD) age of participants was 65.13 (4.86) years, with females comprising 39.7% of the sample. The mean (SD) BDI score was 8.12 (7.11). In crude analyses, for every one-unit increase in BDI score, hsTnT decreased by 0.0069 units on the log-transformed scale (95% CI: –0.0116 to –0.0022, p = 0.0037). This association became not significant in multivariate analyses. In crude sex-stratified analyses, for every one-unit increase in BDI score, NT-proBNP increased by 0.0168 units among females (95% CI: 0.0016 to 0.0321, p = 0.03), while no significant associations were observed in males. After adjustment for covariates, no significant relationships were identified between BDI scores and 3-nitrotyrosine, hsCRP, or PICP.
Conclusions: Depressive symptoms were independently associated with elevated levels of biomarkers specific to myocardial damage and cardiac overload in a population without known cardiovascular disease, in unadjusted and sex-stratified analyses, thought the associations disappear after covariate adjustment. The findings highlight potential sex-specific patterns, particularly with NT-proBNP in females, suggesting a need for further research into the role of depressive symptoms in early cardiac stress among at-risk populations. These findings also support the inclusion of depression screening in cardiovascular risk assessment and suggest a potential for improved cardiovascular outcomes through integrated mental health interventions.
Table of Contents
Abstract 1
Introduction 2
Literature Review 7
Aims and Objectives of this Thesis 9
Methods 10
Study Population and Data 10
Data Analysis 13
Results 16
Discussion 21
Limitations 23
Conclusion and Future Directions 24
References 26
Tables 33
Table 1: Demographic Summary of Study Participants 33
Table 2: Study Participant Characteristics Based on Baseline Depression Scores 34
Table 3: Association Between Cardiac Biomarkers and Baseline Depression Diagnosis 35
Table 4: Spearman’s Rank Correlation of Log-transformed Biomarkers and BDI Scores 36
Table 5: Adjusted R² Comparison Across Full Models 37
Table 6: Unadjusted Analysis of Beck Depression Inventory Scores and Cardiac Biomarkers 38
Table 7: Association between Log-transformed Biomarkers and BDI Scores After Adjusting for Sex, Age, and BMI 39
Table 8: Association of Log-transformed Biomarkers with BDI Scores, All Covariates, After Reducing Multicollinearity 40
Table 9: Sex-Stratified Spearman’s Rank Correlation 41
Table 10: Unadjusted Analysis by Sex, with Log-transformed Biomarkers and BDI Scores 42
Table 11: Fully Adjusted Sex-stratified Analysis of Log-transformed Biomarkers and BDI Scores, With All Covariates, After Reducing Collinearity 43
Figures 44
Figure 1: Flowchart of Methodology 44
Figure 2: Scatterplots of Log-transformed Biomarkers and Beck Depression Inventory (BDI) Scores 45
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