Stress, Depression Associated with Increased CVD Risk in Type 2 Diabetes

Diabetes patients with both depression and stress symptoms had a greater risk for cardiovascular death than having either condition alone.

Patients with diabetes are more likely to have stress or depressive symptoms, which may also put them at an increased risk for cardiovascular disease (CVD), according to recent research published in Diabetes Care.

Doyle M. Cummings, PharmD, FCP, FCCP, from East Carolina University in Greenville, North Carolina, and colleagues evaluated 22 003 adults, of whom 4090 patients had diabetes (mean age, 64 years; 42% black). Fifty-six percent were living in the “Stroke Belt” in the southeastern United States.

Cardiovascular (CV) conditions examined included myocardial infarction, acute coronary heart disease (CHD), CV death, and stroke.

Median follow-up was 5.95 years.

“The presence of elevated stress or depressive symptoms in community-dwelling subjects with diabetes was associated with an increased risk for acute CHD or CV death,” Dr Cummings and colleagues wrote in their study. “Moreover, subjects with diabetes who reported both stress and depressive symptoms together had the greatest risk for acute CHD and CV death.”

Specifically, 36.8% of patients with diabetes also had stress and/or depressive symptoms compared with 29.5% of patients without diabetes (P<.001). Further, there was an increased risk for stroke in diabetes patients with stress and/or depressive symptoms (HR=1.57; 95% CI, 1.05-2.33) as well as CV death (HR=1.53; 95% CI, 1.08-2.17).

Dr Cummings and colleagues noted the combination of both depression and stress symptoms together in patients with diabetes (HR=2.15; 95% CI, 1.33 – 3.47) was associated with a greater risk for CV death compared with either condition alone (HR=1.53; 95% CI, 1.08-2.17) or both depression and stress symptoms but not diabetes (HR=1.27; 95% CI, 0.86-1.88).

“These findings demonstrate the persistent disparities and negative CV impact of these comorbidities at the population level and suggest the need for more careful integration of behavioral screening and management in primary care settings, where most patients with type 2 diabetes are managed,” Dr Cummings and colleagues wrote.


  1. Cummings DM, Kirian K, Howard G, et al. Consequences of Comorbidity of Elevated Stress and/or Depressive Symptoms and Incident Cardiovascular Outcomes in Diabetes: Results From the REasons for the Geographic And Racial Differences in Stroke (REGARDS) Study. Diabetes Care. 2015;doi:10.2337/dc15-1174.