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In Reply: Dr Tzavellas and colleagues suggest that depression could influence our finding that increasing levels of nonfasting triglycerides are associated with increased risk of ischemic stroke. This comment is also relevant to an earlier study demonstrating an association between increasing levels of nonfasting triglycerides and increased risk of myocardial infarction, ischemic heart disease, and early death.¹

Unfortunately, we do not have information on depression in the Copenhagen City Heart Study and therefore cannot include this cardiovascular risk factor in our multivariate analyses. However, for the 1991-1994 examination of the Copenhagen City Heart Study, we do have information on vital exhaustion (a psychological measure characterized by fatigue and depressive symptoms) associated with depression. Using a 17-item questionnaire, participants from the 1991-1994 examination of the Copenhagen City Heart Study were grouped in 4 categories with increasing vital exhaustion.² For depression or vital exhaustion to confound our risk estimates, these factors must . . . [Full Text of this Article]

Jacob Freiberg, MD
Department of Clinical Biochemistry
Herlev Hospital
Copenhagen University Hospital
Herlev, Denmark

Anne Tybjærg-Hansen, MD, DMSc
Department of Clinical Biochemistry
Rigshospitalet
Copenhagen University Hospital
Copenhagen, Denmark

Børge G. Nordestgaard, MD, DMSc
brno@heh.regionh.dk
Department of Clinical Biochemistry
Herlev Hospital
Copenhagen University Hospital

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Nonfasting Triglycerides and Risk of Ischemic Stroke in the General Population
Jacob J. Freiberg, Anne Tybjærg-Hansen, Jan Skov Jensen, and Børge G. Nordestgaard
JAMA. 2008;300(18):2142-2152.
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Triglycerides, Depression, and Risk of Ischemic Stroke
Elias Tzavellas, Dimitrios Karaiskos, and Thomas Paparrigopoulos
JAMA. 2009;301(13):1338-1339.
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