New Insights Into the Comorbidity of Coronary Heart Disease and Depression

Neuroimaging Findings From Cerebral Structure and Function in Coronary Artery Disease

An increasing number of evidence suggests that bidirectional communication between the cardiovascular system and the central nervous system (CNS), known as the heart-brain interaction, is crucial in understanding the impact of coronary artery disease (CAD) on brain health. The multifactorial role of CAD in the brain involves processes such as inflammation, oxidative stress, neuronal activity, neuroendocrine imbalances, and reduced cerebral perfusion, leading to various cerebral abnormalities. The mechanisms underlying the relationship between CAD and brain injury are complex and involve parallel pathways in the CNS, endocrine system, and immune system. Although the exact mechanisms remain partially understood, neuroimaging techniques offer valuable insights into subtle cerebral abnormalities in CAD patients. Neuroimaging techniques, including assessment of neural function, brain metabolism, white matter microstructure, and brain volume, provide information on the evolving nature of CAD-related cerebral abnormalities over time. This review provides an overview of the pathophysiological mechanisms of CAD in the heart-brain interaction and summarizes recent neuroimaging studies utilizing multiparametric techniques to investigate brain abnormalities associated with CAD. The application of advanced neuroimaging, particularly functional, diffusion, and perfusion advanced techniques, offers high resolution, multiparametric capabilities, and high contrast, thereby allowing for the early detection of changes in brain structure and function, facilitating further exploration of the intricate relationship between CAD and brain health. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Explainable machine learning model for assessing health status in patients with comorbid coronary heart disease and depression: Development and validation study

BACKGROUND

Coronary heart disease (CHD) and depression frequently co-occur, significantly impacting patient outcomes. However, comprehensive health status assessment tools for this complex population are lacking. This study aimed to develop and validate an explainable machine learning model to evaluate overall health status in patients with comorbid CHD and depression.

METHODS

Utilizing data from the 2021-2022 Behavioral Risk Factor Surveillance System, we developed and externally validated machine learning models to predict overall health status, defined as having both poor physical and mental health for ≥ 14 days in the past 30 days. Eleven machine learning algorithms were evaluated, including artificial neural networks, support vector machines, and ensemble methods. The SHapley Additive exPlanations (SHAP) method was employed to enhance model interpretability. Model performance was assessed using discrimination, calibration, and decision curve analysis.

RESULTS

The study included 9,747 participants in the derivation cohort and 8,394 in the external validation cohort. Among the eleven algorithms evaluated, an optimized XGBoost model with eight key features demonstrated balanced performance. SHAP analysis revealed that employment status, physical activity, income, and age were the most influential predictors. The model maintained good discrimination (AUC 0.712, 95% CI 0.703-0.721 in derivation; AUC 0.711, 95% CI 0.701-0.721 in validation), calibration and clinical utility across both cohorts.

CONCLUSION

Our explainable machine learning model provides a novel, comprehensive approach to assessing health status in patients with comorbid CHD and depression, offering valuable insights for personalized management strategies.

The genetic association between major depressive disorder and coronary heart disease

Major depressive disorder (MDD) and coronary heart disease (CHD) can both cause significant morbidity and mortality. The association of MDD and CHD has long been identified, but the mechanisms still require further investigation. Seven mRNA microarray datasets containing samples from patients with MDD and CHD were downloaded from Gene Expression Omnibus. Combined matrixes of MDD and CAD were constructed for subsequent analysis. Differentially expressed genes (DEGs) were identified. Functional enrichment analyses based on shared DEGs were conducted to identify pivotal pathways. A protein-protein network was also applied to further investigate the functional interaction. Results showed that 24 overlapping genes were identified. Enrichment analysis indicated that the shared genes are mainly associated with immune function and ribosome biogenesis. The functional interactions of shared genes were also demonstrated by PPI network analysis. In addition, three hub genes including MMP9, S100A8, and RETN were identified. Our results indicate that MDD and CHD have a genetic association. Genes relevant to immune function, especially IL-17 signalling pathway may be involved in the pathogenesis of MDD and CHD.

Lifestyle behaviours do not moderate the association between childhood maltreatment and comorbid depression and cardiometabolic disease in older adults: a meta-analysis

BACKGROUND

Comorbidity between depression and cardiometabolic diseases is an emerging health concern, with childhood maltreatment as a major risk factor. These conditions are also linked to unhealthy lifestyle behaviours such as physical inactivity, smoking, and alcohol intake. However, the precise degree to which lifestyle behaviours moderate the risk between childhood maltreatment and comorbid depression and cardiometabolic disease is entirely unknown.

METHODS

We analysed clinical and self-reported data from four longitudinal studies (Npooled = 181,423; mean follow-up period of 5-18 years) to investigate the moderating effects of physical activity, smoking, and alcohol intake, on the association between retrospectively reported childhood maltreatment and i) depression, ii) cardiometabolic disease and iii) their comorbidity in older adults (mean age range of 47-66 years). Estimates of these moderation effects were derived using multinomial logistic regressions and then meta-analysed.

RESULTS

No meaningful moderation effects were detected for any of the lifestyle behaviours on the association between childhood maltreatment and each health outcome. Physical activity was linked to lower odds of depression (OR [95% CI] = 0.94 [0.92; 0.96]), while smoking was a risk factor for all three outcomes (OR [95% CI] = 1.16 [1.04; 1.31] or larger). Alcohol intake was associated with slightly lower odds of comorbidity (OR [95% CI] = 0.69 [0.66; 0.73]), although this association was not stable across all sensitivity analyses.

CONCLUSIONS

Lifestyle behaviours did not moderate the risk association between childhood maltreatment and depression, cardiometabolic disease, and their comorbidity in older adults. However, we confirmed that childhood maltreatment was associated with these conditions. Further research should address the limitations of this study to elucidate the most optimal targets for intervention.

Predicting incident cardio-metabolic disease among persons with and without depressive and anxiety disorders: a machine learning approach

PURPOSE

There is a global increase of cardiovascular disease and diabetes (Cardio-Metabolic diseases: CMD). Suffering from depression or anxiety disorders increases the probability of developing CMD. In this study we tested a wide array of predictors for the onset of CMD with Machine Learning (ML), evaluating whether adding detailed psychiatric or biological variables increases predictive performance.

METHODS

We analysed data from the Netherlands Study of Depression and Anxiety, a longitudinal cohort study (N = 2071), using 368 predictors covering 4 domains (demographic, lifestyle & somatic, psychiatric, and biological markers). CMD onset (24% incidence) over a 9-year follow-up was defined using self-reported stroke, heart disease, diabetes with high fasting glucose levels and (antithrombotic, cardiovascular, or diabetes) medication use (ATC codes C01DA, C01-C05A-B, C07-C09A-B, C01DB, B01, A10A-X). Using different ML methods (Logistic regression, Support vector machine, Random forest, and XGBoost) we tested the predictive performance of single domains and domain combinations.

RESULTS

The classifiers performed similarly, therefore the simplest classifier (Logistic regression) was selected. The Area Under the Receiver Operator Characteristic Curve (AUC-ROC) achieved by singe domains ranged from 0.569 to 0.649. The combination of demographics, lifestyle & somatic indicators and psychiatric variables performed best (AUC-ROC = 0.669), but did not significantly outperform demographics. Age and hypertension contributed most to prediction; detailed psychiatric variables added relatively little.

CONCLUSION

In this longitudinal study, ML classifiers were not able to accurately predict 9-year CMD onset in a sample enriched of subjects with psychopathology. Detailed psychiatric/biological information did not substantially increase predictive performance.

Identifying factors contributing to kinesiophobia in patients post-percutaneous coronary intervention

OBJECTIVE

This study aims to investigate the factors contributing to kinesiophobia in patients following percutaneous coronary intervention (PCI).

METHODS

Purposive sampling was employed to conduct semi-structured interviews with 14 patients and 4 healthcare professionals who satisfied the inclusion and exclusion criteria, from May 2023 to June 2023. Data were coded, categorized, and thematically analyzed using the Colaizzi seven-step analysis method.

RESULTS

The factors contributing to kinesiophobia in patients post-PCI were classified into four primary themes: heightened psychological stress, increased uncertainty regarding exercise, reduced self-efficacy, and inadequate support systems.

CONCLUSION

Kinesiophobia in patients post-PCI hinders adherence to cardiac rehabilitation protocols. Early identification and analysis of the factors contributing to kinesiophobia can guide the development and implementation of effective intervention strategies.

CLINICAL REGISTRATION NUMBER

Not applicable.

Study of psychosocial factors and endothelial dysfunction in coronary heart disease patients

OBJECTIVE

To provide valuable insight into the prevention and treatment of coronary heart disease, this study aimed to explore the association between psychosocial elements and endothelial dysfunction in diagnosed patients.

METHODS

Using a cross-sectional study design, we selected patients with coronary heart disease who visited the cardiology department of our hospital from January to December 2021. According to coronary angiography results, patients were divided into the coronary stenosis group (≥50%) and the normal coronary group (<50%), with 100 cases in each group. We assessed the levels of psychosocial factors using the Type A Behaviour Pattern Scale (TABP), Self-Rating Anxiety Scale (SAS), Social Support Rating Scale (SSRS), and Self-Rating Depression Scale (SDS). Endothelial synthesis of nitric oxide (NOx) and endothelium-dependent (EDF) and endothelium-independent (NEDF) vasodilation functions were measured and compared using enzyme-linked immunosorbent assay (ELISA) and colour Doppler ultrasonography, respectively.

RESULTS

Patients in the coronary stenosis group had significantly higher scores in Type A behaviour, anxiety, and depression and significantly lower scores in social support compared with the normal coronary group (t = 3.21, 4.15, 3.87; p < 0.05; t = -2.96; p < 0.05). EDF, NEDF, and NOx levels were significantly lower in the coronary stenosis group than in the normal coronary group (t = -4.32, -3.76, -4.67; p < 0.05). Psychosocial factors were negatively correlated with endothelial function indices (r = -0.31 to -0.48; p < 0.05). Multiple linear regression analysis revealed that Type A behavioural anxiety, depression, and social support were independent risk factors influencing endothelial dysfunction (β = -0.23, -0.26, -0.21, -0.19; p < 0.05).

CONCLUSION

A close relationship was observed between psychosocial factors and endothelial dysfunction in patients with coronary heart disease. Assessment and intervention of psychosocial factors in these patients should be strengthened to improve endothelial function and reduce the risk of cardiovascular events.

Persistent depressive symptom trajectory is associated with cognitive impairment: a population-based longitudinal study of aging in Taiwan

BACKGROUND

To investigate the associations between five depressive symptom trajectories and cognitive impairment in Taiwan's older population. In addition, we investigated the moderating factors influencing these associations.

METHODS

This population-based, longitudinal, cohort study was conducted on the basis of the Taiwan Longitudinal Study on Aging. Data corresponding to the fifth (2003), sixth (2007), and seventh (2011) survey waves were analyzed, focusing on individuals aged ≥ 65 years. Depressive symptom trajectories were analyzed using the 10-item Centre for Epidemiological Studies Depression scale, and cognitive function was assessed using the Short Portable Mental State Questionnaire. Logistic regression models were adjusted for various covariates such as sociodemographic, lifestyle, and health-related variables. We also investigated moderating effects of sex, age, type 2 diabetes mellitus, hypertension, and coronary heart disease.

RESULTS

Five trajectories of depressive symptoms included 1,549 older individuals were identified. Approximately 36.09%, 47.13%, 5.68%, 6.20%, and 4.91% exhibited no, mild, decreasing, increasing, and persistent depressive symptom trajectories, respectively. The odds ratios for cognitive impairment were 3.17 (95% confidence interval [CI]: 1.41-7.15) in Model 1; 3.24 (95% CI: 1.42-7.41) in Model 2; and 2.95 (95% CI: 1.24-7.00) in Model 3 in individuals with persistent depressive symptom trajectory. Only persistent depressive symptom trajectory reached statistical significance in all three models. Cognitive decline was evident across all trajectories. The rate of cognitive decline was more rapidly in the persistent depressive symptom trajectory, nearly twofold to no depressive symptom trajectory, which the corresponding β values (score/year) were - 0.0862, - 0.1020, - 0.1192, - 0.1206, and - 0.1683 for the no, mild, decreasing, increasing, and persistent depressive symptom trajectories, respectively. Female sex, older age, type 2 diabetes mellitus, and coronary heart disease were significant moderators on the risk of cognitive impairment.

DISCUSSION

Persistent depressive symptoms is associated with cognitive impairment in older adults. Identifying high-risk subgroups is crucial for targeted assistance. Policymakers and health-care professionals should be informed accordingly.

Screening Depression in Ischemic Heart Disease: Gender Differences and Psychosocial Implications Using a Self-Developed Questionnaire

Background/Objectives: Ischemic heart disease (IHD) is a major cause of morbidity and mortality worldwide, and it is frequently associated with depression, which can negatively impact both clinical outcomes and quality of life. The relationship between IHD and depression is complex, with gender differences influencing the severity of depression and willingness to seek psychological support. This study aims to evaluate the prevalence and severity of depression in IHD patients using the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ) and to explore gender differences in depression severity and help-seeking behavior. Methods: This cross-sectional study involved 103 patients diagnosed with IHD (62 males, 41 females), with data collected from two general practice clinics in Arad, Romania, between November 2023 and November 2024. Participants completed the DA-IHDQ, a self-developed questionnaire designed to screen for depression in IHD patients. The questionnaire categorizes depression severity into four grades: minimal to no depression, mild depression, moderate depression, and severe depression. The study also assessed participants' interest in receiving psychological support. Descriptive and inferential statistical analyses were performed, and the psychometric properties of DA-IHDQ, including its reliability (Cronbach's α = 0.957) and diagnostic accuracy (sensitivity = 90.0%, specificity = 98.8%), were evaluated. Results: Mild depression was the most common grade in both male and female IHD patients, while severe depression was the least prevalent. Males had a higher overall frequency of depression, with more cases of mild depression, whereas females had a higher proportion of moderate and severe depression. Additionally, males demonstrated significantly lower interest in psychological or psychiatric help, while females showed greater willingness to seek mental health support. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. Conclusions: The findings highlight the high prevalence of depression in IHD patients and the gender disparities in mental health engagement, emphasizing the need for targeted psychological interventions. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. Future research should explore the barriers to help-seeking among male IHD patients and develop gender-sensitive strategies to improve access to mental health services.

Construction and Validation of a Major Depression Risk Predictive Model for Patients with Coronary Heart Disease: Insights from NHANES 2005-2018

Background

This study aimed to develop and validate a predictive model for major depression risk in adult patients with coronary heart disease (CHD), offering evidence for targeted prevention and intervention.

Methods

Using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, 1098 adults with CHD were included. A weighted logistic regression model was applied to construct and validate a nomogram-based prediction tool for major depression in this population.

Results

The weighted prevalence of major depression among these patients was 13.95%. Multivariate weighted logistic regression revealed that waist circumference, smoking status, arthritis, sleep disorders, and restricted work capacity were independent risk factors for major depression (odds ratio (OR) >1, p < 0.05). The areas under the receiver operating characteristic (ROC) curve in the nomogram model for both the development and validation cohorts were 0.816 (95% confidence interval (CI): 0.776-0.857) and 0.765 (95% CI: 0.699-0.832), respectively, indicating the model possessed strong discriminative ability. Brier scores in the development and validation cohorts were 0.107 and 0.127, respectively, both well below the 0.25 threshold, demonstrating good calibration. Decision curve analysis (DCA) showed that when the threshold probability for major depression ranged from 0.04 to 0.54 in the development group and from 0.08 to 0.52 in the validation group, the nomogram provided the highest clinical net benefit compared to "Treat All" and "Treat None" strategies, confirming its strong clinical utility.

Conclusions

With a weighted prevalence of 13.95%, this nomogram model shows excellent predictive performance and clinical relevance for predicting major depression risk in patients with CHD. Thus, the model can be applied to aid healthcare professionals in identifying high-risk individuals and implementing targeted preventive strategies, potentially lowering the incidence of major depression in this patient population.

Association between the Fatty Liver Index (FLI) and incident coronary heart disease: insights from a cohort study on the Chinese population

Background

The debate persists regarding whether metabolic dysfunction-associated steatotic liver disease (MASLD) actively contributes to coronary heart disease or merely acts as a passive indicator.

Objective

This research aims to clarify the relationship between liver fat accumulation, as quantified by FLI, and the risk of developing coronary heart disease.

Methods

Conducted from April to November 2011, the REACTION project, spearheaded by the Endocrinology Branch of the Chinese Medical Association, focused on Chinese adults aged 40 and above. Comprehensive data collection employed both questionnaires and specialized medical equipment, covering physical measurements, blood pressure, and pertinent biochemical markers. The study population excluded those with pre-existing coronary heart disease and acute myocardial infarction. Based on the initial data, participants were segmented and grouped into three categories. Analytically, the study utilized Cox proportional hazards models, further enhanced by stratified analyses to identify variations within predefined demographic groups.

Results

In this study, we enrolled 8,647 participants, comprising 2,887 males and 5,760 females. Over the 10-year non-interventional follow-up period, 433 participants (5%) passed away due to various reasons, with 55 deaths attributed to coronary heart disease/myocardial infarction, accounting for 12.7% of total deaths. Additionally, 484 participants were diagnosed with new-onset coronary heart disease, resulting in an incidence rate of 5.5%. Spearman correlation analysis revealed a positive correlation between FLI and traditional risk factors for coronary heart disease, including age, male gender, abnormal glucose metabolism, hypertension, smoking, TG, TC, LDL-C, etc. The Log-rank test indicated a rising cumulative incidence of coronary heart disease with increasing FLI groupings (P<0.01). Moreover, Cox regression analysis highlighted a notable correlation between FLI levels as a risk factor and the onset of coronary heart disease. After adjusting for other risk factors, individuals in the 30≤FLI<60 group exhibited a 1.203-fold higher risk of coronary heart disease compared to those in the FLI<30 group (p=0.126), while participants in the FLI≥60 group had a 1.386-fold higher risk than those in the FLI<30 group (p=0.041).

Conclusion

Elevated FLI values are strongly associated with an increased susceptibility to coronary heart disease, indicating its potential value as a prognostic marker for the condition.

Metabolomic Profiling Reveals Biomarkers in Coronary Heart Disease Comorbidity

Background and Aims: Coronary heart disease (CHD), hypertension (HTN), depression (Dep), and Type 2 diabetes mellitus (T2DM) are often comorbid, resulting in an exacerbated patient condition and worsened prognosis. A lack of systematic metabolomic studies on comorbidities of CHD remains. Therefore, comprehensive metabolomic-based evaluation of comorbidities of CHD is necessary. Methods and Results: In the current study, 169 healthy subjects, 149 CHD subjects, 107 CHD + HTN subjects, 126 CHD + Dep subjects, and 58 CHD + T2DM subjects were recruited. Gas chromatography-mass spectrometry was used for metabolite determination, and multivariate statistical analysis was conducted to identify metabolites that are differentially expressed with the comorbidities of CHD. There were 9, 16, 14, and 10 metabolites identified in the healthy and CHD group, the CHD and CHD + HTN group, the CHD and CHD + Dep group, and the CHD and CHD + T2DM group, respectively. Six metabolic pathways were affected, involving starch and sucrose metabolism; fructose and mannose metabolism; citrate cycle; alanine, aspartate, and glutamate metabolism; fatty acid biosynthesis; and glycolysis. Conclusion: Our study has systematically elucidated the metabolic changes underlying the comorbidities of CHD, thereby providing insight into the mechanisms associated with these alterations.

Gender-Specific Insights into Depression in Patients with Ischemic Heart Disease: Findings from a Pilot Study Using a Self-Developed Questionnaire

BACKGROUND/OBJECTIVES

Ischemic heart disease (IHD) significantly affects mental health, with gender-specific differences being observed in psychological responses. This pilot study aimed to explore these differences in the demographic, clinical, psychological, psychiatric, and social profile of patients diagnosed with IHD.

METHODS

A descriptive, cross-sectional design was used, recruiting 183 adult patients diagnosed with coronary artery disease and depression at the Psychiatry Department of Arad County Emergency Hospital, Romania, between May 2021 and May 2024. Data were collected using a self-developed tool, named the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ), alongside standardized assessments. Statistical analysis was performed using JASP statistical software (Version 0.19.1, University of Amsterdam, Amsterdam, Netherlands), employing binomial and multinomial tests for categorical data, and Cronbach's alpha was used to assess internal consistency.

RESULTS

This study found significant demographic differences, with female patients exhibiting higher levels of emotional distress and severe depression compared with the male subjects. Women reported greater social isolation and a stronger desire to seek for psychological or psychiatric support. Furthermore, a positive correlation between depression severity and physical symptoms was observed in both genders.

CONCLUSIONS

These findings highlight the importance of recognizing gender-specific responses to IHD, emphasizing the need for tailored interventions in mental healthcare and cardiac rehabilitation. Future research should further explore these differences to enhance the understanding of the psychosocial/psychiatric aspects of IHD and improve patient outcomes.

Unraveling the Role of the Blood-Brain Barrier in the Pathophysiology of Depression: Recent Advances and Future Perspectives

Depression is a highly prevalent psychological disorder characterized by persistent dysphoria, psychomotor retardation, insomnia, anhedonia, suicidal ideation, and a remarkable decrease in overall well-being. Despite the prevalence of accessible antidepressant therapies, many individuals do not achieve substantial improvement. Understanding the multifactorial pathophysiology and the heterogeneous nature of the disorder could lead the way toward better outcomes. Recent findings have elucidated the substantial impact of compromised blood-brain barrier (BBB) integrity on the manifestation of depression. BBB functions as an indispensable defense mechanism, tightly overseeing the transport of molecules from the periphery to preserve the integrity of the brain parenchyma. The dysfunction of the BBB has been implicated in a multitude of neurological disorders, and its disruption and consequent brain alterations could potentially serve as important factors in the pathogenesis and progression of depression. In this review, we extensively examine the pathophysiological relevance of the BBB and delve into the specific modifications of its components that underlie the complexities of depression. A particular focus has been placed on examining the effects of peripheral inflammation on the BBB in depression and elucidating the intricate interactions between the gut, BBB, and brain. Furthermore, this review encompasses significant updates on the assessment of BBB integrity and permeability, providing a comprehensive overview of the topic. Finally, we outline the therapeutic relevance and strategies based on BBB in depression, including COVID-19-associated BBB disruption and neuropsychiatric implications. Understanding the comprehensive pathogenic cascade of depression is crucial for shaping the trajectory of future research endeavors.

Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people

PURPOSE

The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group.

METHODS

All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician.

RESULTS

In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072-1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086-1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868-0.931) and digitalis (OR 0.864, 95% CI 0.828-0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs.

CONCLUSION

In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.

Short-Term Blood Pressure Variability among Young Adults at High or Low Risk for Depression

Background: Depression has been shown to have adverse effects on blood pressure (BP) and is associated with high blood pressure variability (BPV). In turn, high short-term BPV has been related to eventual cardiovascular risk. But it is not clear how early in adulthood the detrimental effects of depression on BPV may be discerned, if being at high risk for depression also compromises BPV, and whether the clinical features of depression moderate its adverse effects. We investigated these three issues among young adults using an office-like setting. Methods: In total, 218 subjects with a history of childhood-onset major depressive episodes (probands), 206 never-depressed full biological siblings of the probands (high-risk siblings), and 166 emotionally healthy unrelated controls received a psychiatric evaluation and three standardized-sitting BP measurements 5 min apart. Short-term BPV was defined as the maximum difference between measures (range) for each case. The statistical methods included analyses of variance/covariance, chi-square tests, and multiple regression. Results: Systolic and diastolic BP decreased over consecutive measurements (p < 0.001). After controlling for age, the probands, siblings, and controls did not differ significantly in terms of BPV. However, the number of lifetime depressive episodes did predict the diastolic BP range (p = 0.005): probands with the highest number of depressive episodes had the largest short-term diastolic BPV. Conclusions: On a group level, the adverse effects on BPV of having experienced or being at high risk for depression are not yet evident during young adulthood. However, the number of major depressive episodes, which is an index of lifetime depression burden, predicts higher BPV. Thus, BPV monitoring for young adults with clinical depression histories could be part of an early intervention program to reduce the risk of eventual cardiovascular disease.

Effects of daily sleep on physical activity after cardiac surgery

BACKGROUND

Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients.

OBJECTIVES

This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery.

METHODS

Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses.

RESULTS

Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time.

CONCLUSIONS

Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.

Efficacy and safety evaluation of Ginkgo biloba dropping pill (GBDP) on stable angina pectoris complicated with depression: A placebo-controlled, randomized, double-blind, multicenter study

BACKGROUND

Stable angina pectoris (SAP) is a clinical condition characterized by reversible and temporary myocardial ischemia and hypoxia. A majority of SAP patients also experience depressive disorders, which adversely affect their disease prognosis and overall quality of life. However, the clinical utility of existing antidepressants is constrained by their side effects. Ginkgo biloba dropping pill (GBDP), a Chinese patented medication, has demonstrated efficacy in the treatment of both coronary heart disease and mental disorders. This prospective, randomized, double-blind, multicenter clinical trial aimed to assess the effectiveness and safety of GBDP as an adjuvant therapy for SAP complicated by depression.

METHODS

Participants were randomly assigned in a 1:1 ratio to receive either GBDP or a placebo (5 pills, three times a day) in addition to standard therapy for a duration of 12 weeks. The Seattle Angina Questionnaire (SAQ) was administered every 4 weeks during the treatment, and angina event frequency was assessed weekly. The 36-item Short-Form (SF-36) and Hamilton Depression Scale (HAMD) scores were measured both before and after the treatment.

RESULTS

Out of the 72 patients, 68 (n = 34 per group) completed the entire study. At the first visit (4 weeks ± 3 days), the SAQ-Angina Stability score in the GBDP group was significantly higher than that in the placebo group (p < 0.05). While the average weekly frequency of angina episodes in the placebo group notably increased after 12 weeks of treatment (p < 0.05), it displayed an improving trend in the GBDP group (p > 0.05). By the endpoint, each subcategory score of SF-36 in the GBDP group exhibited significant improvement compared to baseline (p < 0.05). The comparison of score improvement between the two groups revealed that the SF-PCS score of the GBDP group was higher than that of the placebo group (p < 0.05). HAMD scores in both groups significantly increased after treatment (p < 0.05). No discernible difference in the incidence of adverse reactions was observed between the two groups (p > 0.05).

CONCLUSION

In patients with SAP complicated by depression, GBDP, when combined with standard treatment, rapidly and safely alleviates angina pectoris symptoms. It demonstrates therapeutic potential in enhancing the quality of life and alleviating depressive symptoms.

Gut microbiota connects the brain and the heart: potential mechanisms and clinical implications

Nowadays, high morbidity and mortality of cardiovascular diseases (CVDs) and high comorbidity rate of neuropsychiatric disorders contribute to global burden of health and economics. Consequently, a discipline concerning abnormal connections between the brain and the heart and the resulting disease states, known as psychocardiology, has garnered interest among researchers. However, identifying a common pathway that physicians can modulate remains a challenge. Gut microbiota, a constituent part of the human intestinal ecosystem, is likely involved in mutual mechanism CVDs and neuropsychiatric disorder share, which could be a potential target of interventions in psychocardiology. This review aimed to discuss complex interactions from the perspectives of microbial and intestinal dysfunction, behavioral factors, and pathophysiological changes and to present possible approaches to regulating gut microbiota, both of which are future directions in psychocardiology.

Construction of a depression risk prediction model for type 2 diabetes mellitus patients based on NHANES 2007-2014

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent global health issue that has been linked to an increased risk of depression. The objective of this study was to construct a nomogram model for predicting depression in T2DM patients.

METHODS

A total of 4280 patients with T2DM were included in this study from the 2007-2014 NHANES. The entire dataset was split randomly into training set comprising 70 % of the data and a validation set comprising 30 % of the data. LASSO and multivariate logistic regression analyses identified predictors significantly associated with depression, and the nomogram was constructed with these predictors. The model was assessed by C-index, calibration curve, the hosmer-lemeshow test and decision curve analysis (DCA).

RESULTS

The nomogram model comprised of 9 predictors, namely age, gender, PIR, BMI, education attainment, smoking status, LDL-C, sleep duration and sleep disorder. The C-index of the training set was 0.780, while that of the validation set was 0.752, indicating favorable discrimination for the model. The model exhibited excellent clinical applicability and calibration in both the training and validation datasets. Moreover, the cut-off value of the nomogram is 223.

LIMITATIONS

This study has shortcomings in data collection, lack of external validation, and results non-extrapolation.

CONCLUSIONS

Our nomogram exhibits high clinical predictability, enabling clinicians to utilize this tool in identifying high-risk depressed patients with T2DM. It has the potential to decrease the incidence of depression and significantly improve the prognosis of patients with T2DM.

Hydrogels Loaded with Atorvastatin-Metal Organic Framework Have a Preventive Effect on Coronary Heart Disease

In the research, a new three-dimensional coordination polymer was synthesized by solvothermal method based on the metal ligand LCu =[Cu(2,4-pydca)2 ]2- (2,4-pydca=pyridine-2,4-dicarboxylate) and alkaline-earth ion CaII with chemical composition {[Ca(H2 O)2 ][LCu ]⋅DMSO ⋅ 2H2 O}n (1) (DMSO=dimethyl sulfoxide). The complex 1 was characterized soundly by Fourier transform infrared (FT-IR) spectroscopy, elemental analysis (EA), single-crystal X-ray diffraction (SCXRD) and thermogravimetric analysis (TGA). Using atorvastatin as drug model, carboxymethyl chitosan and calcium alginate as raw materials, a new type of metal gel particles was prepared. The microstructure of the gel was observed by scanning Electron Microscope (SEM) and its modulation effect on the activity of human cardiomyocytes was evaluated. The results show that the gel particles presented a three-dimensional porous structure and were able to significantly up-regulate the cell activity of human cardiomyocytes, which is expected to develop the metal gel particles into drugs for the treatment of coronary heart disease.

Landscape of gut microbiota and metabolites and their interaction in comorbid heart failure and depressive symptoms: a random forest analysis study

IMPORTANCE

There is increasing evidence that alterations in gut microbial composition and function are associated with cardiovascular or psychiatric disease. Therefore, it is meaningful to investigate the taxonomic and functional characterization of the microbiota in HF patients who also have depressive symptoms. In this cross-sectional study, Cloacibacillus and alpha-tocopherol were determined as new diagnostic markers. Furthermore, intestinal microecosystem disorders are closely linked to depressive symptoms in HF patients, providing a new reference viewpoint for understanding the gut-heart/brain axis.

Health-Related Quality of Life and Influencing Factors in Coronary Heart Disease Based on the Scale QLICD-CHD (V2.0): A Cross-Sectional Study

Purpose

Coronary heart disease (CHD) is difficult to cure, so more attention should be paid to improving patients' health-related quality of life (HRQoL). This paper focuses on identifying factors that affect HRQoL.

Patients and Methods

Overall, 189 in-patients with coronary heart disease were investigated at the Affiliated Hospital of Guangdong Medical University between 2015 and 2016. The scale Quality of Life Instruments for Chronic Diseases-Coronary heart disease (QLICD-CHD V2.0) was used to evaluate HRQoL and collect demographic information. Medical records were applied to collect patients' clinical indicators. A simple correlation analysis, Student's t-test, and a one-way analysis of variance were first performed to filter factors that might associate with HRQoL, and multiple linear regression was applied to finally identify related factors.

Results

Findings from multiple linear regression showed that the total score was related to family economy, treatment, indirect bilirubin, and albumin with regression coefficient B=5.209, -6.615, 0.378, and 0.548, respectively. The physical functions were related to treatment, albumin, globular proteins, chloride, and red blood cell count with B=-9.031, 1.000, 0.612, 1.320, and 5.161, respectively. The psychological function was in association with family economy, clinical course, serum phosphorus, and percentage of lymphocyte population with B=7.487, 6.411, -16.458, and 0.090, respectively. The social function was associated with family economy, blood urea nitrogen, serum creatinine, and platelet distribution width with B=7.391, 1.331, -0.060, and -0.929, respectively. The special module was in association with treatment, indirect bilirubin, and serum calcium with B=-7.791, 0.414, and 23.017, respectively.

Conclusion

Clinical indicators including albumin, globular proteins, chloride, red blood cell count, serum phosphorus, percentage of lymphocyte population, blood urea nitrogen, serum creatinine, platelet distribution width, indirect bilirubin, and serum calcium, as well as socio-demographic factors including the family economy, clinical course, and treatment, may affect coronary heart disease patients' HRQoL.

Is there a cost to caring? Dispositional affective empathy interacts with depressive symptoms to predict higher C-reactive protein 8 years later

Affective empathy, including the tendency to vicariously experience the emotions of others, is a highly-valued prosocial trait, but has been previously found to be associated with higher chronic inflammation cross-sectionally and to interact with the levels of depressive symptoms in important social partners. The current study utilized prospective longitudinal data from a nationally representative study of adults in the United States to assess whether dispositional affective empathy interacted with one's own depressive symptoms to predict C-reactive protein (CRP) approximately eight years later. Results revealed that higher ratings of empathy predicted higher CRP, but only among individuals with lower levels of depressive symptoms. Higher depressive symptoms related to greater inflammation regardless of dispositional empathy and perceived stress did not account for observed associations. Taken together, these findings suggest that vicariously experiencing others' emotions may come at a biological cost, which, if sustained, may place individuals at greater risk for inflammatory diseases.

Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression (GLAD Study): A Randomized Double-Blind Placebo-Controlled Study

OBJECTIVE

To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

METHODS

From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12.

RESULTS

In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred.

CONCLUSIONS

GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).

A bibliometric analysis of research on heart failure comorbid with depression from 2002 to 2021

Heart failure (HF) with depression is a common comorbidity associated with worse clinical status and quality of life. Although there have been numerous high-quality studies and relevant reviews on HF comorbid with depression, few bibliometric analyses of this field have been reported. In order to understand the development process, research hotspots and future directions, this review analyzes the papers on HF comorbid with depression from January 2002 to December 2021 through CiteSpace and VOSviewer. Visual cooperative networks between countries, authors and institutions were conducted to understand the basic development status of HF comorbid with depression. Furthermore, we performed co-occurrence analysis, burst detection, and timeline analysis for keywords to understand this field's research directions and hotspots. Finally, a detailed review and analysis of the classical literature in this field were conducted based on co-citation analysis. This bibliometric analysis provides an overview of studies on HF comorbid with depression and emphasizes the research on comorbidity mechanisms and more effective interventions as a priority for future research.

Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males

OBJECTIVES

We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex.

METHODS

Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms.

RESULTS

Males had a larger total effect (β= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males.

CONCLUSION

These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.

Role of Multifaceted Social Relationships on the Association of Loneliness with Depression Symptoms: A Moderated Mediation Analysis

Strong relationship exists between loneliness and depression in older adults. However, the effect of multifaceted social relationships on the relationship between loneliness and depression has not been explored. The purpose of the current study was to find out how multifaceted social relationships affect the aforementioned processes. We investigated and evaluated the loneliness status, depression symptoms, social relationships, and demographic information of 1116 older adults aged ≥65 years living in rural Japan. The final 555 participants were included in the analysis. Statistical evidence showed a direct effect between loneliness and depression symptoms. Additionally, the mediation model found that social curiosity and participation acted as mediators between loneliness and depression symptoms. Further, independence and participation, independence, and feeling safe played a conditional moderating role in the model of loneliness-social curiosity-depression symptoms and loneliness-participation-depression symptoms, respectively. Interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator. The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators.

Mechanisms of Xiong-Pi-Fang in treating coronary heart disease associated with depression: A systematic pharmacology strategy and in vivo pharmacological validation

BACKGROUND

Coronary heart disease (CHD) and depression are very common and often co-existing disorders. Xiong-Pi-Fang (XPF), a therapeutic classical traditional Chinese medicine (TCM) formula, has shown satisfactory efficacy in treating CHD associated with depression. However, its mechanism of action is still unknown.

PURPOSE

To employ a systematic pharmacology approach for identifying the action mechanisms of XPF in treating CHD associated with depression.

METHODS

We used a systematic pharmacology approach to identify the potential active mechanisms of XPF in treating CHD with depression. Potential active compounds in XPF and the diseases targets were screened using relevant databases to build corresponding pathways, following the experiments that were conducted to confirm whether the presumptive results of systemic pharmacology were correct.

RESULTS

Network pharmacology predicted 42 key targets and 20 signaling pathways involved in XPF-mediated treatment, with IL-6/JAK2/STAT3/HIF-1α/VEGF-A pathway significantly affected. The common influences were hypothalamic-pituitary-adrenal axis (HPA axis) and glucocorticoid signaling, validated through chronic unexpected mild stress (CUMS) with isoprenaline (ISO) for inducing CHD within the depression model in rats. In addition, XPF intake reduced depressive-like behaviors and improved ECG ischemic changes. Furthermore, XPF exerted some anti-inflammatory effects by inhibiting the interleukin-6 (IL-6) induced phosphorylation of janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3), ultimately downregulating hypoxia-inducible factor 1-α (HIF-1α) and vascular endothelial growth factor-A (VEGF-A) activation. The dysfunctional HPA axis feedback loop was also regulated, which enhanced the glucocorticoid receptor (GR) expression. In contrast, it improved glucocorticoid resistance by reducing the mineralocorticoid receptor expression.

CONCLUSIONS

Suppressing IL-6 release and maintaining the HPA feedback loop balance could be the primary mechanism of XPF against CHD with depression. The significance of the IL-6 and HPA axis identified indicates their potential as essential targets for CHD therapy with depression.

Gut microbiome metabolites as key actors in atherosclerosis co-depression disease

Cardiovascular diseases, mainly characterized by atherosclerosis (AS), and depression have a high comorbidity rate. However, previous studies have been conducted under a single disease, and there is a lack of studies in comorbid states to explore the commonalities in the pathogenesis of both diseases. Modern high-throughput technologies have made it clear that the gut microbiome can affect the development of the host's own disorders and have shown that their metabolites are crucial to the pathophysiology of AS and depression. The aim of this review is to summarize the current important findings on the role of gut microbiome metabolites such as pathogen-associated molecular patterns, bile acids, tryptophan metabolites, short-chain fatty acids, and trimethylamine N -oxide in depression and AS disease, with the aim of identifying potential biological targets for the early diagnosis and treatment of AS co-depression disorders.

Prophylactic administration of rosmarinic acid ameliorates depression-associated cardiac abnormalities in Wistar rats: Evidence of serotonergic, oxidative, and inflammatory pathways

Psychiatric disorders and associated cardiac comorbidities have increased the risk of mortality worldwide. Researchers reported that depression increases the possibility of future cardiac abnormalities by approximately 30%. Therefore, there is an unmet need to develop therapeutic interventions to treat depression and associated cardiac abnormalities. The present study was conducted to evaluate the prophylactic effect of rosmarinic acid (RA) against chronic unpredictable stress (CUS)-induced depression associated cardiac abnormalities in Wistar rats. The CUS paradigm, which comprised several stressors, was employed for 40 days to induce depressive-like behavior and associated cardiac abnormalities in rats. Along with CUS, RA at a dose of 25 and 50 mg/kg was administered orally to two groups of animals for 40 days. Behavioral tests (forced swim test and sucrose consumption test) and molecular biomarkers (corticosterone and serotonin) were performed. Electrocardiography was performed before CUS (Day 0), Day 20, and Day 40 to study electrocardiogram parameters. Furthermore, changes in body weight, organ weight, tissue lipid peroxidation, glutathione, catalase, cTn-I, MMP-2, and proinflammatory cytokines (TNF-α and IL-6) were estimated. Our results showed that RA treatment caused a reduction in immobility period, adrenal hyperplasia, corticosterone level, tissue lipid peroxidation, cTn-I, MMP-2, proinflammatory cytokines, and QRS complex duration, while an increase in sucrose consumption, brain serotonin level, T-wave width, glutathione, and catalase activity as compared with the CUS-control group. The results of our study proved that RA administration ameliorates CUS-induced depression-associated cardiac abnormalities in rats via serotonergic, oxidative, and inflammatory pathways.

Quality of life of patients with coronary heart disease treated with the bioresorbable vascular scaffold (ABSORB™): 2-year results from the GABI-R-registry

Background

Numerous studies have reported clinical endpoints following coronary revascularization using bioresorbable vascular scaffolds (BVS), while information about the impact on health-related quality of life is sparse. In this analysis of the German-Austrian ABSORB RegIstRy, the 2 year results concerning quality of life development in a large cohort of patients treated with BVS were reported.

Methods

Data were collected at baseline as well as 30 days, 6 and 24 months after coronary revascularization using BVS. The EQ-5D score, EQ visual analogue scale (VAS) and Seattle Angina Questionnaire (SAQ) were determined for each time point. Patients were categorized according to the indication for coronary revascularization [acute coronary syndrome (ACS), stable angina pectoris (SAP), silent myocardial ischemia (SMI), or other]. Binary logistic regression analysis was performed to determine factors that predict above-average scores two years after implantation.

Results

Data from 1317 patients in 88 centres were included. Reasons for revascularization were: ACS (n = 643), SAP (n = 443), SMI (n = 52), and other (n = 179). Mean EQ-5D was significantly increased after six months, while a value comparable to baseline was found two years after implantation. EQ VAS and four of five dimensions of SAQ were significantly improved over baseline at all follow-up surveys. Particularly strong improvements were seen in SAQ scores angina frequency and quality of life. Binary regressions showed different statistically significant predictors in the respective models.

Conclusions

Following coronary revascularization with BVS strong decrease in self-reported angina frequency and increase of self-reported quality of life were observed with continuous improvements over two years of follow-up.

Trial registration ClinicalTrials.gov Identifier: NCT02066623.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02815-2.

Early Diagnosis and Treatment of Coronary Heart Disease with Image Features of Optical Coherence Tomography under Adaptive Segmentation Algorithm

This research was aimed at exploring the application value of optical coherence tomography (OCT) images under adaptive segmentation algorithm in the early diagnosis of coronary heart disease (CHD). Eighty-two patients with CHD were included, who were to undergo coronary angiography (CAG) to confirm their condition. According to the diagnostic criteria of CHD in the American Coronary Artery Surgery Study (CASS), the patients were divided into the stable plaque group (41 cases) and unstable plaque group (41 cases). Besides, 20 healthy volunteers were selected as the control group, and all of them underwent OCT scans. On the basis of a fourth-order partial differential equation (PDE) and active contour (AC) model, a novel adaptive image segmentation algorithm PDE-AC was constructed and used for OCT image processing. No significant difference was found in general clinical data and serological indicators in the control group compared to the other two groups (P > 0.05). The lipid plaque length, degree of stenosis, and lipid pool angle, macrophages and intimal erosion, and plaque fissure in the unstable plaque group were highly greater than those in the stable plaque group. The fibrous cap thickness (FCT) was significantly thinner than that in the stable plaque group (P < 0.05). The diagnostic sensitivity, specificity, and accuracy of OCT under PDE-AC algorithm for CHD (91.53%, 84.08%, and 95.38%) were markedly higher than those of single OCT (83.46%, 75.11%, and 88.02%) (P < 0.05). In summary, OCT images under PDE-AC algorithm did better than simple OCT images in the diagnosis of CHD. Lipid plaque length, degree of stenosis, and lipid pool angle, macrophage and intimal erosion, plaque fissure, and FCT were important indicators for judging plaque stability, having the better clinical application value.

Brain-Derived Neurotrophic Factor And Coronary Artery Disease

Coronary artery disease (CAD) is defined as myocardial damage developing as a result of its organic and functional changes, and leading to impaired blood flow through the coronary arteries. An important pathogenetic component of CAD is atherosclerosis. Currently, key aspects of the molecular relationship between inflammation and atherosclerosis are being actively studied, the immunometabolic theory of atherosclerosis is being discussed, along with an involvement of perivascular adipose tissue in the pathogenesis of this pathology, due to its ability to respond to atherogenic stimuli via developing inflammatory reactions. Evidence has been accumulated that in patients with CAD, both in their blood and perivascular adipose tissue, the level of neurotrophic factors (in particular, brain-derived neurotrophic factor, BDNF) changes, which may be a promising area of research from the standpoint of studying this factor as a therapeutic target for atherosclerosis in CAD. Neurotrophic growth factors control the functioning of both immune and nervous systems, and the balance of energy metabolism and innervation of adipose tissue. They affect vascular homeostasis, and are also involved in causing and stopping inflammation. Currently, there are data on the role of BDNF in the pathogenesis of cardiovascular, neurodegenerative and metabolic diseases, and on the effect of polyunsaturated fatty acids and eicosanoids on the level of BDNF and, accordingly, the development and progression of coronary artery atherosclerosis. Our review summarizes published data (2019-2021) on the pathophysiological and pathogenetic mechanisms of the relationship between BDNF and CAD (atherosclerosis).

Depression: a predictor of coronary heart disease in Saudi Arabia

Aims and Objectives: This research study mainly deals to evaluate the effect of depression in coronary heart disease patients. Background: Depression is one of the common comorbidity among patients presented with acute coronary syndrome or those with major cardiovascular event. Depression has been independently associated or lead to acute cardiac events in patients. Method: The study was conducted from three months followed-up patients with recent diagnosed coronary heart disease and they getting treatment from cardiac centres “Armed Forces Hospitals. Depression was evaluated by using 17-item Hamilton Rating Scale and the cardiac outcome was assessed clinically by echo parameters and cardiac biomarkers such as C-reactive Protein. The data were analysis by SPSS version 23. Results: In this study 83 patients were part of this research. The patients had been picked up from range 18-65 year in which mostly patients were male (75%) than female (25%). Among 83 coronary heart disease patients 29.5% were suffering from depression while 19.5% were on severity. The deterioration factor was significantly influence by depression and smoking. Conclusion: Depression has a great impact on deterioration of the cardiac outcomes. It can serve as a predictive variable for future cardiological morbidity and mortality.

The relation of common inflammatory cytokines with anxiety and depression and their values in estimating cardiovascular outcomes in coronary heart disease patients

Background

Inflammatory cytokines are associated with the occurrence and severity of psychological disorders in cerebro‐cardiovascular disease patients. This study aimed to investigate the correlation of inflammatory cytokines with anxiety and depression in coronary heart disease (CHD) patients and their values for estimating cardiovascular outcomes.

Methods

Totally, 150 CHD patients and 50 healthy subjects were enrolled. Then, tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, IL‐10, and IL‐17 in their serum samples were detected using ELISA assay; anxiety and depression were assessed by the HADS score. For CHD patients, major adverse cardiac events (MACE) were recorded and evaluated.

Results

CHD patients presented with increased TNF‐α (median: 50.0 vs. 37.0 pg/ml, p < 0.001), IL‐1β (median: 2.7 vs. 2.0 pg/ml, p < 0.001), IL‐6 (median: 24.7 vs. 24.3 pg/ml, p = 0.032), IL‐17A (median: 58.6 vs. 43.6 pg/ml, p < 0.001), HADS‐A score (p < 0.001), HADS‐D score (p < 0.001), anxiety rate (p < 0.001), and depression rate (p < 0.001) compared to healthy subjects. Then, TNF‐α (p = 0.003), IL‐1β (p = 0.023), and IL‐17A (p < 0.001) were related to elevated HADS‐A score. Also, TNF‐α (p = 0.014) and IL‐17A (p = 0.020) positively, while IL‐10 (p = 0.047) negatively related to the HADS‐D score in CHD patients. Interestingly, elevated TNF‐α and IL‐17A were associated with anxiety and depression occurrence in CHD patients (all p < 0.05). Inspiringly, only TNF‐α high, but not other cytokines, was related to elevated accumulating MACE (p = 0.041), while no correlation of anxiety (p = 0.173) or depression (p = 0.068) with accumulating MACE was observed.

Conclusion

TNF‐α and IL‐17A correlate with anxiety and depression, while only TNF‐α high is related to elevated accumulating MACE in CHD patients.

Brain-heart communication in health and diseases

Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.

Efficacy of Wen-Dan Decoction in the treatment of patients with coronary heart disease: A protocol for systematic review and meta-analysis

BACKGROUND

Coronary heart disease (CHD) is a heart disease caused by myocardial ischemia, hypoxia or necrosis due to stenosis or occlusion of lumen caused by coronary atherosclerosis. It belongs to ischemic cardiomyopathy and is more common in clinic. Previous studies have shown that Wen-Dan Decoction (WDD) is safe and effective, but there is a lack of systematic reviews. The purpose of this study is to systematically study the efficacy of WDD in the treatment of patients with CHD.

METHODS

We will search the following databases: PubMed, EMBASE, Web of Science, Central, Chinese databases China Biomedical Literature, Wanfang Chinese digital periodical and conference database (Wanfang Database), China National Knowledge Infrastructure database, and VIP Chinese Science and Technique Journals Database (VIP) from inception to August 2021. All published randomized controlled trials related to this study will be included. The ongoing or unpublished trials will be searched from National Institutes of Health clinical registry Clinical Trials, International Clinical Trials Registry Platform and the Chinese clinical trial registration platform. Two researchers separately screened the literature and extracted data. The primary outcome is total effective rate. The RevMan V5.3 will be used to evaluate literature and data analysis synthesis.

RESULTS

This study will provide a reliable evidence-based basis for the clinical application of WDD in the treatment of patients with CHD.

CONCLUSION

The effectiveness of WDD for CHD will be evaluated.

UNIQUE INPLASY NUMBER

2021110001.

Phenotypic Disease Network Analysis to Identify Comorbidity Patterns in Hospitalized Patients with Ischemic Heart Disease Using Large-Scale Administrative Data

Ischemic heart disease (IHD) exhibits elevated comorbidity. However, few studies have systematically analyzed the comorbid status of IHD patients with respect to the entire spectrum of chronic diseases. This study applied network analysis to provide a complete picture of physical and mental comorbidities in hospitalized patients with IHD using large-scale administrative data. Hospital discharge records from a provincial healthcare database of IHD inpatients (n = 1,035,338) and one-to-one matched controls were included in this retrospective analysis. We constructed the phenotypic disease networks in IHD and control patients and further assessed differences in comorbidity patterns. The community detection method was applied to cluster diagnoses within the comorbidity network. Age- and sex-specific patterns of IHD comorbidities were also analyzed. IHD inpatients showed 50% larger comorbid burden when compared to controls. The IHD comorbidity network consisted of 1941 significant associations between 71 chronic conditions. Notably, the more densely connected comorbidities in IHD patients were not within the highly prevalent ones but the rarely prevalent ones. Two highly interlinked communities were detected in the IHD comorbidity network, where one included hypertension with heart and multi-organ failures, and another included cerebrovascular diseases, cerebrovascular risk factors and anxiety. Males exhibited higher comorbid burden than females, and thus more complex comorbidity relationships were found in males. Sex-specific disease pairs were detected, e.g., 106 and 30 disease pairs separately dominated in males and females. Aging accounts for the majority of comorbid burden, and the complexity of the comorbidity network increased with age. The network-based approach improves our understanding of IHD-related comorbidities and enhances the integrated management of patients with IHD.

Effects of Teaching Resourcefulness in Patients with Coronary Heart Disease

This cluster randomized controlled trial aimed to investigate the effects of an intervention to teach resourcefulness on depression and coping style of patients with coronary heart disease (CHD). A convenience sample of 72 patients in community settings took part. Participants in the intervention group (n = 36) received an 8-week intervention based on the concept of resourcefulness, plus routine health education. Participants in the control group (n = 36) received routine health education only. After the intervention, participants in the intervention group had significantly higher scores on resourcefulness and coping styles, and lower scores on depression than those in the control group (both ps < .001). The findings suggest that a well-developed intervention to teach resourcefulness could help patients with CHD to be more resourceful, improve their level of depression, and choose more effective strategies to cope with stress.

Five-Animal Frolics Exercise Improves Anxiety and Depression Outcomes in Patients with Coronary Heart Disease: A Single-Blind Randomized Controlled Trial

INTRODUCTION

The patients with coronary heart disease (CHD) always have emotional implications. As the branch of traditional Chinese medicine, Five-Animal Frolics Exercise (FAE) is a popular mind-body exercise in China and shown to improve emotional wellbeing.

AIM

We aimed to explore the effects of FAE on the emotional disorders of CHD patients.

METHODS

CHD patients were assigned into an experiment group (EG, FAE) and a control group (CG, routine nursing care). We measured serum levels of miR-124 and miR-135 and scores of the Hamilton Depression/Anxiety scale (HAMD/HAMA), Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), Short Form 36 Health Survey Questionnaire (SF-36), and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

After a 3-month FAE intervention, serum levels of miR-124 and miR-135 and the scores of HAMD/HAMA, SAS, SDS, and PSQI in the EG group were lower than those in the CG group, while SF-36 scores in the EG group were higher than those in the CG group (p < 0.05). Serum levels of miR-124 and miR-135 had a strong relationship with SAS and SDS scores (p < 0.05). Discussion/Implications for Practice. The study suggests that FAE intervention controls anxiety and depression outcomes and improves life quality in CHD patients by affecting serum levels of miR-124 and miR-135.

Prevalence and predisposing factors of depressive symptoms in patients with stable coronary artery disease: a cross-sectional single-center study

The incidence of depressive symptoms in patients with stable coronary artery disease (SCAD) has significantly increased. However, its pathogenesis and treatment mechanisms are still incompletely understood. In this study, 144 patients with SCAD were recruited. Depressive symptoms of patients with SCAD were evaluated using Zung Self-Rating Depression Scale during hospitalization, and the patients were categorized into two subgroups: the non-depressive and depressive groups (further divided into mild and moderate/severe depressive groups). The rate of moderate/severe depressive symptoms in patients with SCAD was 18.8%. The mean age of patients in the depressive and mild depressive groups was older than that of those in the non-depressive group, and patients in the moderate/severe depressive group had higher high-density lipoprotein (HDL) and lower creatinine (Cr) levels. Binary logistic regression analysis showed that lower low-density lipoprotein (LDL) levels were significantly associated with increased risks of mild depressive symptoms, whereas higher HDL and lower Cr levels were significantly associated with moderate/severe depressive symptoms, suggesting that patients with SCAD were prone to experience depressive symptoms, especially in the elderly. Abnormality in LDL, HDL, and Cr levels might contribute to the depressive symptoms.

Serum Levels of FGF21, β-Klotho, and BDNF in Stable Coronary Artery Disease Patients With Depressive Symptoms: A Cross-Sectional Single-Center Study

Background: The incidence of depressive symptoms (DS) in patients with stable coronary artery disease (SCAD) is significantly higher than those in healthy population, and that DS are independent risk factors for cardiovascular events. Previous studies have reported that fibroblast growth factor 21 (FGF21), β-klotho, mature brain-derived neurotrophic factor (mBDNF), and BDNF precursor (proBDNF) play important roles in the pathogenesis and treatment of coronary heart disease and depression. With this in mind, the present study aimed to clarify the relationship between FGF21, β-klotho, mBDNF, and proBDNF and SCAD with comorbid depression, in addition to also exploring the underlying mechanisms of these disease processes. Methods: A total of 116 patients with SCAD and 45 healthy controls were recruited. Patients with SCAD were further divided into two subgroups based on the Zung Self-Rating Depression Scale (SDS), which were characterized as those with no DS (NDS) and those with DS. Baseline data were collected, and serum levels of FGF21, β-klotho, mBDNF, and proBDNF were determined. Results: In SCAD patients, Gensini scores-denoting the degree of coronary arteriostenosis-were significantly greater in the DS group than in the NDS group. There was also a positive correlation between the Gensini scores and the SDS scores. Patients in the SCAD group demonstrated a lower serum FGF21. Serum β-klotho, mBDNF, and mBDNF/proBDNF were also significantly lower in the DS group than in the NDS group. Furthermore, β-klotho and mBDNF were negatively correlated with the SDS scores. Additionally, SCAD patients were divided into lower- and higher-level groups using hierarchical cluster analysis, with the results highlighting that patients in the lower mBDNF group had a higher incidence of DS. Conclusions: The depression score was positively correlated with the severity of coronary artery stenosis, and serum FGF21, β-klotho, mBDNF, and proBDNF were closely related to the development of DS in patients with SCAD. These observations suggest FGF21, β-klotho, mBDNF, and proBDNF as potential diagnostic and/or therapeutic targets for SCAD with co-morbid depression.

Inflammation associated with coronary heart disease predicts onset of depression in a three-year prospective follow-up: A preliminary study

Depression frequently co-occurs with coronary heart disease (CHD), worsening clinical outcomes of both, and inflammation has been proposed as a biological link between these two disorders. The aim of the present study was to investigate the role of inflammation in the development of depression in CHD patients during a 3-year follow-up. We examined the inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), measured at baseline, as a potential predictor of later onset of depression. We recruited 89 CHD patients, who were assessed at baseline and then every 6 months, for three years. The sample included, at baseline, 25 depressed and 64 non-depressed CHD patients, as confirmed by Clinical Interview Schedule Revised (CIS-R). Depressive symptoms were assessed at baseline and all follow-up points by the Patient Health Questionnaire-9 (PHQ-9). In all CHD patients (n = 89), we found a significant positive correlation between hsCRP levels and the severity of depressive symptoms at baseline (PHQ-9, r = 0.23, p = 0.032). During follow-up, n = 21 patients (of the 64 non-depressed at baseline) developed depression, defined as being PHQ-9 positive (a score ≥ 10) in at least one follow-up assessment. Of these, n = 9 subjects were defined as developing clinically-significant depression, that is, having a positive PHQ-9 in at least 3 of the 6 follow-up assessments, implying a duration of symptoms of at least one year. We found that increased hsCRP values at baseline predicted future onset of depression. Specifically, baseline hsCRP values were higher in patients who later developed clinically-significant depression (mean ± SD; 6.76 ± 6.52 mg/L) compared with never-depressed (2.77 ± 3.13 mg/L; F(1,48) = 7.29, p = 0.010), even after controlling for baseline PHQ-9 scores. In conclusion, inflammation in CHD patients is associated with future development of clinically-significant depression. HsCRP, a reliable and ready-to-use biological marker of inflammation, may help to identify depression high-risk phenotypes even among CHD patients, who already have high baseline inflammation. Our study conveys important preliminary findings that will require further replication but that have the potential to affect the mental and physical health of a vulnerable group of individuals.