DIABETES, DEPRESSION, & CORONARY HEART DISEASE

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。糖尿病和抑郁症都单独增加了女性患冠心病的风险。因此，更好地了解这些风险因素如何相互作用对我们了解女性心脏病至关重要。抑郁症-糖尿病-冠心病关系的一个假设机制是下丘脑轴和皮质醇的产生。目前，还没有公布过将这些变量放在一起研究的数据。因此，尚不清楚它们是否各自传达一种单独的风险，当它们组合在一起时会变成附加的风险，或者它们是否相互作用以传达多重风险。这项被提议的研究是一项关于女性抑郁、糖尿病和冠心病风险的横断面研究。本研究设计为2X2因子设计。样本将由80名年龄匹配的绝经后妇女组成。自变量是1)是否有抑郁史（是或否）和2)是否有2型糖尿病（是或否）。相关变量包括唾液皮质醇水平、血脂（总胆固醇、高密度脂蛋白亚组分和甘油三酯）、腰臀比、肱动脉血流介导的扩张、止血指标（vWF）、炎症标志物（c反应蛋白）、微量白蛋白尿和血压。控制的变量包括BMI、降脂剂、受体阻滞剂、ACE抑制剂、降压药、吸烟史、体育活动史和饮酒史。将测试三个假设：1)糖尿病将会有主要影响，糖尿病参与者会比没有糖尿病的参与者表现出更高的WHR、血压、vWf、CRP、血脂异常、微量白蛋白尿和更多的EDBR受损；2)抑郁史是主要影响因素，抑郁史阳性受试者的WHR、血压、vWf、CRP、微量白蛋白尿、EDBR受损程度较高，皮质醇脉动昼夜节律较低；3)抑郁史与糖尿病之间存在交互作用，糖尿病合并抑郁史的受试者WHR、血压、vWf、CRP、EDBR均高于仅有抑郁史或糖尿病史的受试者。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetes and depression both independently put women at increased risk for coronary heart disease. Thus, a better understanding of how these risk factors interact is crucial to our understanding of heart disease in women. One hypothesized mechanism for the depression-diabetes-CHD relationship is the HPA axis and cortisol production. Currently, no data have been published that look at these variables in concert. Thus, it is unclear if they each convey an individual risk that becomes additive when combined, or if they interact to convey multiplicative risk. The study being proposed is a cross sectional study of depression, diabetes, and CHD risk in women. The research design is a 2X2 factorial design. The sample will consist of 80 age-matched postmenopausal women. The independent variables are 1) presence of a history of depression (yes or no), and 2) T2DM status (yes or no). The dependent variables are salivary cortisol levels, lipids (total cholesterol, HDL subfractions, and triglycerides), waist-to-hip ratio, brachial artery flow mediated dilation, hemostatic indicator (vWF), inflammatory marker (c-reactive protein), microalbuminuria, and blood pressure. Variables that will be controlled for include BMI, lipid lowering agents, beta blockers, ACE inhibitors, antihypertensive agents, and history of smoking, physical activity, and alcohol use. Three hypotheses will be tested: 1) There will be a main effect for diabetes, such that participants with diabetes will show higher WHR, blood pressure, vWf, CRP, dyslipidemia, microalbuminuria, and more impaired EDBR than those without diabetes; 2) There will be a main effect for history of depression, such that participants a positive history will show higher WHR, blood pressure, vWf, CRP, microalbuminuria, more impaired EDBR, and a flatter cortisol pulsatile circadian rhythm than those with a negative history; 3) there will be an interaction between history of depression and diabetes, such that participants with both diabetes and positive history of depression will show higher WHR, blood pressure, vWf, CRP, and more impaired EDBR, than those with only history of depression or diabetes.