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To the Editor: In their prospective cohort study, Dr Freiberg and colleagues¹ found that patients with elevated nonfasting triglyceride levels had an increased adjusted relative risk for ischemic stroke. The estimation of the hazard ratio was performed using Cox regression adjusted for age, sex, and other major cardiovascular risk factors such as hypertension, total cholesterol level, and smoking. However, depression as a risk factor was not included in the multivariate model, although some studies have demonstrated an association between stroke and mood disorders.²

Depressed patients may have an increased risk of cardiovascular disease, and depression may be a predictor of recurrent cerebrovascular events, leading to higher morbidity and mortality rates.³ Furthermore, depression, through mechanisms not yet elucidated, may affect other modifiable risk factors for stroke, such as hypertension, smoking, and levels of physical activity. A cohort study⁴ has suggested an association between high triglyceride levels and certain "type A" personality . . . [Full Text of this Article]

Elias Tzavellas, MD; Dimitrios Karaiskos, MD; Thomas Paparrigopoulos, MD
tpaparrig@med.uoa.gr
Department of Psychiatry
Athens University Medical School
Athens, Greece

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