Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2021;45:379-89)

Inha Jung; Eun-Jung Rhee; Won-Young Lee

doi:10.4093/dmj.2021.0222

Articles

Page Path: HOME > Diabetes Metab J > Volume 45(5); 2021 > Article

Response Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2021;45:379-89): Inha Jung, Eun-Jung Rhee, Won-Young Lee; Diabetes & Metabolism Journal 2021;45(5):793-794.
DOI: https://doi.org/10.4093/dmj.2021.0222
Published online: September 30, 2021

5,340 Views
69 Download
3 Crossref
3 Scopus

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding authors: Eun-Jung Rhee

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea E-mail: hongsiri@hanmail.net

Won-Young Lee

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

Full Article

Download PDF

NOTES
REFERENCES
About this article

See the letter "Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study" on page 379.

We would like to thank Jin Hwa Kim for her valuable comments and interest in our article, entitled “Increased risk of cardiovascular disease and mortality in patients with diabetes and coexisting depression: a nationwide population-based cohort study” [1]. We are pleased that Kim recognized the value of our study, which is reflecting the effects of psychologic aspects on cardiovascular disease (CVD) among diabetic patients in Korea.

In our study using the Korean National Health Insurance Service and claims data, we found that participants with diabetes and prolonged coexisting depression have higher risk for CVD and all-cause mortality than patients who required short-term treatment for depression. The global prevalence of depression in the general population has significantly increased during the coronavirus disease 2019 (COVID-19) pandemic [2,3]. Given this situation, individualized diabetes management including psychological interventions should be provided by clinicians amid the pandemic.

We agree with Kim’s opinion that further prospective studies are required to evaluate the long-term effects of interventions for depression on CVD outcomes in diabetic patients or to compare the effects on CVD between non-pharmacological interventions and pharmacological interventions for depression. To date, several trials have aimed to examine whether treatment for depression improves CVD outcomes in patients with heart disease. The Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) evaluated use of an antidepressant sertraline versus placebo for depressed patients with acute myocardial infarction (MI) or unstable angina, suggesting antiplatelet and endothelium-protective properties of sertraline [4]. The Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial was a randomized trial comparing cognitive behavioral therapy versus usual care following MI within the past 30 days [5]. However, there is not sufficient evidence regarding pharmacotherapy or psychotherapy for depression in prevention of cardiac events among Asian patients with diabetes. A large, randomized, controlled trial to address this question is required; however, patients with depression are at high risk for CVD and should not be assigned to a placebo group owing to ethical problems.

As Kim suggested, it would be helpful to consider the severity of diabetes in our study. Unfortunately, we were unable to obtain laboratory data such as glycosylated hemoglobin to assess the degree of glucose control. Future research using other databases with more information regarding the severity of diabetes is required.

We agree with Kim’s suggestions for future studies. We should take into account the potential effects of smoking and alcohol not only at study baseline, but also during the whole follow-up period. Since we could not rule out the possibility of unknown influence of comorbidities, we should exclude comorbidities such as chronic disease and cancer.

Although our observational study has several limitations, we suggest that either recurrent depression or even a single episode of depression in diabetics should be identified and treated appropriately. We would like to thank Kim again for her insightful comments on our article.

NOTES

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Jung I, Kwon H, Park SE, Han KD, Park YG, Kim YH, et al. Increased risk of cardiovascular disease and mortality in patients with diabetes and coexisting depression: a nationwide population-based cohort study. Diabetes Metab J 2021;45:379-89.Article PubMed PDF
2. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2019686.Article PubMed PMC
3. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health 2020;16:57.Article PubMed PMC PDF
4. Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, et al. Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation 2003;108:939-44.Article PubMed
5. Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106-16.Article PubMed

Figure & Data

References

Citations

Citations to this article as recorded by

Predicting depression severity using machine learning models: Insights from mitochondrial peptides and clinical factors
Toheeb Salahudeen, Maher Maalouf, Ibrahim (Abe) M. Elfadel, Herbert F. Jelinek, Ian James Martins
PLOS One.2025; 20(5): e0320955. CrossRef
Impact of type 2 diabetes on the risk of cardiovascular disease and cardiovascular mortality in patients with non-alcoholic fatty liver disease: a nationwide population-based study
Eun Roh, Han Na Jung, Ji Hye Heo, Kyungdo Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm
BMJ Public Health.2025; 3(1): e002020. CrossRef
Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes
Keiliany Rivera-Santiago, Eduardo Cumba-Aviles, Demivette Gómez-Rivera
Health Psychology Report.2023;[Epub] CrossRef

PubReader
ePub Link

Cite this Article

Cite this Article: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2021;45:379-89)

Diabetes Metab J. 2021;45(5):793-794. Published online September 30, 2021

DOI: https://doi.org/10.4093/dmj.2021.0222

XML Download

Related articles

Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2021;45:379-89)

About this article

Jung I, Rhee EJ, Lee WY. Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2021;45:379-89). Diabetes Metab J. 2021;45(5):793-794.

DOI: https://doi.org/10.4093/dmj.2021.0222.

Download citation ↓