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Lu Q, Wang Y, Geng T, Zhang Y, Tu Z, Pan A, Liu G. Depressive symptoms, lifestyle behaviors, and risk of cardiovascular disease and mortality in individuals of different socioeconomic status: A prospective cohort study. J Affect Disord 2024; 347:345-351. [PMID: 37989438 DOI: 10.1016/j.jad.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Depression is a global health issue, associated with increased risk of cardiovascular disease (CVD) and premature death, but whether the association varied across different socioeconomic status (SES), and mechanisms responsible for this association is unclear. We aimed to evaluate the association of depressive symptoms with the risk of incident CVD and mortality in people of low, medium, and high SES, and determine the extent to which lifestyle behaviors could explain the association. METHODS This study included 314,800 participants from the UK Biobank. Depressive symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2). Information on socioeconomic status and lifestyle was obtained from baseline assessment. RESULTS During 12 years of follow-up, 29,074 incident CVD cases and 16,673 deaths were documented. The increased CVD risk in participants with depressive symptoms (versus without) was more pronounced as SES decreased, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.30 (1.22, 1.39), 1.27 (1.17, 1.37), and 1.17 (0.97, 1.41) in participants of low, medium, and high SES, respectively. The corresponding HRs (95% CIs) for all-cause mortality were 1.16 (1.07, 1.26), 1.21 (1.08, 1.36), and 1.24 (0.95, 1.61). In addition, multiple lifestyle factors together explained 14.4% to 32.8% of the elevated CVD and mortality risk due to depressive symptoms. LIMITATIONS Moderate sensitivity of PHQ-2, lacked information on the severity of depression, baseline measurement of lifestyle. CONCLUSIONS Depressive symptoms were associated with higher risks of incident CVD and mortality, especially in low SES groups, and lifestyle behaviors only explained a moderate proportion of the association. These findings indicated that health policies targeting healthy lifestyle promotion alone might not be sufficient, and other measures tackling social inequity are warranted to attenuate the elevated health risk due to depression.
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Affiliation(s)
- Qi Lu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuexuan Wang
- Department of Applied Statistics, Johannes Kepler Universität Linz, Linz, Austria
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanbo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, USA
| | - Zhouzheng Tu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Pan R, Fan Q, Tao R. Depression Following Acute Coronary Syndrome: A Review. Rev Cardiovasc Med 2023; 24:247. [PMID: 39076389 PMCID: PMC11270108 DOI: 10.31083/j.rcm2409247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 07/31/2024] Open
Abstract
Depression is common among patients with acute coronary syndrome (ACS). Although multiple studies have confirmed that depression is an independent risk factor for poor outcomes in ACS, general awareness of this issue is still limited. Ongoing research has described detailed aspects of depression in ACS, with various mechanistic hypotheses put forward to explain the complexity of this comorbidity. Several investigations have explored management strategies in this subgroup of patients, including screening for depression, antidepressant treatment, and cardiac rehabilitation. However, evidence of long-term improvement in clinical outcomes is still scarce, and a more comprehensive understanding of the underlying mechanisms that link depression with ACS is required to further improve disease management.
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Affiliation(s)
- Roubai Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 200025 Shanghai, China
| | - Qin Fan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 200025 Shanghai, China
| | - Rong Tao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 200025 Shanghai, China
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Crespo-Ramos G, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Fang R, Ehrmann D, Presley C, Naik AD, Katona A, Walker EA, Cherrington A, Gonzalez JS. Emotional distress and cardiovascular disease risk among participants enrolled in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study. Diabetes Res Clin Pract 2023; 203:110808. [PMID: 37394014 PMCID: PMC10592312 DOI: 10.1016/j.diabres.2023.110808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
AIMS People with type 2 diabetes (T2DM) have an increased risk of cardiovascular disease (CVD). We examined depressive symptoms (DS) and diabetes distress (DD) in relation to the estimated 10-year risk of CVD in adults with T2DM enrolled in the GRADE Emotional Distress Substudy. METHODS Linear regression models examined the associations of baseline DS and DD with estimated 10-year risk of CVD using the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, adjusting for age, sex, race/ethnicity, education, income, diabetes duration, diabetes-related complications, and HbA1c. RESULTS A total of 1,605 GRADE participants were included: 54% Non-Latino (NL) White, 18% Latino, 19% NL-Black, 66% male, mean age 57.5 (SD = 10.25) years, diabetes duration 4.2 (SD = 2.8) years, and HbA1c 7.5% (SD = 0.5%). After incorporating covariates, only DS, especially cognitive-affective symptoms, were associated with ASCVD risk (estimate = 0.15 [95% CI: 0.04, 0.025], p = 0.006). Higher DS remained significantly associated with higher ASCVD risk when adding DD to covariates (estimate = 0.19 [95% CI: 0.07, 0.30], p = 0.002). DD was not associated with ASCVD risk when accounting for covariates. CONCLUSIONS Depressive symptoms, particularly cognitive-affective symptoms, are associated with increased 10-year predicted ASCVD risk among adults with early T2DM. Diabetes distress is not significantly associated with the predicted ASCVD risk when accounting for covariates.
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Affiliation(s)
- Gladys Crespo-Ramos
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | | | - Ran Fang
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Caroline Presley
- Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL, USA
| | - Aanand D Naik
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | | | - Elizabeth A Walker
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Cherrington
- Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL, USA
| | - Jeffrey S Gonzalez
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
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Staff TE, O’Leary M, Fretts AM. Depression, physical activity, and incident cardiovascular disease among American Indians: The strong heart family study. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100125. [PMID: 37397507 PMCID: PMC10312118 DOI: 10.1016/j.psycom.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Little is known about the relationship of depression with incident cardiovascular disease (CVD) among American Indians (AIs), a population with a high burden of depressive symptoms and CVD. In this study, we examined the association of depressive symptoms with CVD risk among AIs and assessed whether an objective marker of ambulatory activity influenced the relationship. Methods The study comprised participants from the Strong Heart Family Study, a longitudinal study of CVD risk among AIs free of CVD at baseline (2001-2003) and who participated in a follow-up examination (n = 2209). The Center for Epidemiologic Studies of Depression Scale (CES-D) was used to assess depressive symptoms and depressive affect. Ambulatory activity was measured using Accusplit AE120 pedometers. Incident CVD was defined as new myocardial infarction, coronary heart disease, or stroke (through 2017). Generalized estimating equations were used to examine the association of depressive symptoms with incident CVD. Results 27.5% of participants reported moderate or severe depressive symptoms at baseline and 262 participants developed CVD during follow-up. Compared to participants who reported no depressive symptoms, the odds ratios for developing CVD among those who reported mild, moderate, or severe symptoms were: 1.19 (95% CI: 0.76, 1.85), 1.61 (95% CI: 1.09, 2.37), and 1.71 (95% CI: 1.01, 2.91), respectively. Adjustment for activity did not alter findings. Limitations CES-D is a tool used to identify individuals with depressive symptoms and not a measure of clinical depression. Conclusion Higher levels of reported depressive symptoms were positively associated with CVD risk in a large cohort of AIs.
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Affiliation(s)
- Torrie Eagle Staff
- Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA
| | - Amanda M. Fretts
- University of Washington Department of Epidemiology, Seattle, WA, USA
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Adkins-Hempel M, Japuntich SJ, Chrastek M, Dunsiger S, Breault CE, Ayenew W, Everson-Rose SA, Nijjar PS, Bock BC, Wu WC, Miedema MD, Carlson BM, Busch AM. Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial. Addict Sci Clin Pract 2023; 18:29. [PMID: 37173792 PMCID: PMC10175930 DOI: 10.1186/s13722-023-00388-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. METHOD/DESIGN The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. DISCUSSION Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. TRIAL REGISTRATION ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta. CLINICALTRIALS gov/study/NCT03413423 .
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Affiliation(s)
- Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Sandra J Japuntich
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
| | - Christopher E Breault
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Woubeshet Ayenew
- Division of Cardiology, Department of Medicine, Hennepin Healthcare, 900 South 8th St., O5, Minneapolis, MN, 55415, USA
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Susan A Everson-Rose
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Beth C Bock
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, 700 Butler Drive, Providence, RI, 02906, USA
| | - Wen-Chih Wu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Center of Innovation in Long Term Services and Support, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
- Cardiovascular Rehab Center, Lifespan, 208 Collyer St., Providence, RI, 02904, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, 920 East 28th St., Suite 480, Minneapolis, MN, 55407, USA
| | - Brett M Carlson
- North Memorial Health Heart and Vascular Center, 3300 Oakdale Ave. N., Suite 200, Robbinsdale, MN, 55422, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA.
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA.
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA.
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
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Reuter K, Genao K, Callanan EM, Cannone DE, Giardina EG, Rollman BL, Singer J, Slutzky AR, Ye S, Duran AT, Moise N. Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy. Circ Cardiovasc Qual Outcomes 2022; 15:e009338. [PMID: 36378766 PMCID: PMC9909565 DOI: 10.1161/circoutcomes.122.009338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression leads to poor health outcomes in patients with coronary heart disease (CHD). Despite guidelines recommending screening and treatment of depressed patients with CHD, few patients receive optimal care. We applied behavioral and implementation science methods to (1) identify generalizable, multilevel barriers to depression screening and treatment in patients with CHD and (2) develop a theory-informed, multilevel implementation strategy for promoting guideline adoption. METHODS We conducted a narrative review of barriers to depression screening and treatment in patients with CHD (ie, medications, exercise, cardiac rehabilitation, or therapy) comprising data from 748 study participants. Informed by the behavior change wheel framework and Expert Recommendations for Implementing Change, we defined multilevel target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multilevel implementation strategy, targeting health care systems/providers and patients. RESULTS We identified implementation barriers at the system/provider level (eg, Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (eg, Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. Expert Recommendations for Implementing Change strategies included learning collaborative, audit, feedback, and educational materials. The final multicomponent strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (electronic shared decision-making) tool with several functions for patients, for example, patient activation, patient treatment selection support. CONCLUSIONS We applied implementation and behavioral science methods to identify implementation barriers and to develop a multilevel implementation strategy for increasing uptake of depression screening and treatment in patients with CHD as a use case. The multilevel implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.
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Affiliation(s)
- Katja Reuter
- Department of Medicine, SUNY Upstate Medical University, New York, USA
| | - Kirali Genao
- Columbia University Irving Medical Center, New York, USA
| | | | | | - Elsa-Grace Giardina
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Bruce L. Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessica Singer
- Columbia University Irving Medical Center, New York, USA
| | - Amy R. Slutzky
- Health Sciences Library, SUNY Upstate Medical University, New York, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, USA
| | | | - Nathalie Moise
- Columbia University Irving Medical Center, New York, USA
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The combined role of obesity and depressive symptoms in the association with ischaemic heart disease and its subtypes. Sci Rep 2022; 12:14419. [PMID: 36002471 PMCID: PMC9402922 DOI: 10.1038/s41598-022-18457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022] Open
Abstract
This cross-sectional study aimed to explore the combined effects of depression and obesity on ischemic heart disease and its subtypes. Data from the National Health and Nutrition Examination Survey 2007–2018 were used. A total of 29,050 participants aged 20 years or older were included in the analyses. Logistic regression models and restricted cubic spline models were applied to evaluate the associations between depression symptom and ischemic heart disease. There were significant correlations between depressive symptoms and ischemic heart disease [OR and 95% CI 2.44 (1.91, 3.10)] and its subtypes: coronary heart disease [2.32 (1.67, 3.23)], heart attack [2.18 (1.71, 2.78)], and angina [2.72 (1.96, 3.79)].The synergistic effects of depression with obesity (BMI ≥ 30) and central obesity (waist ≥ 102/88 cm for men/women) on ischemic heart disease were estimated and expressed using the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). The RERI and AP with 95% CIs of depression and central obesity for ischemic heart disease were 1.10 (0.01, 2.19) and 0.35 (0.06, 0.64). When we analysed the other three subtypes of ischemic heart disease, we only found depressive symptoms and central obesity could have a meaningful synergistic effect on heart attack (RERI: 0.84 (− 0.28, 1.96) AP: (0.31 (0.00, 0.69)).
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Chen X, Liu Z, Yang Y, Chen G, Wan Q, Qin G, Yan L, Wang G, Qin Y, Luo Z, Tang X, Huo Y, Hu R, Ye Z, Shi L, Gao Z, Su Q, Mu Y, Zhao J, Chen L, Zeng T, Li Q, Shen F, Chen L, Zhang Y, Wang Y, Deng H, Liu C, Wu S, Yang T, Li M, Xu Y, Xu M, Wang T, Zhao Z, Lu J, Bi Y, Yu X, Wang W, Ning G. Depression Status, Lifestyle, and Metabolic Factors With Subsequent Risk for Major Cardiovascular Events: The China Cardiometabolic Disease and Cancer Cohort (4C) Study. Front Cardiovasc Med 2022; 9:865063. [PMID: 35694670 PMCID: PMC9177939 DOI: 10.3389/fcvm.2022.865063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background We aimed to evaluate the association between depression and major cardiovascular events and test whether the relationship between depression and cardiovascular events is influenced by lifestyle or metabolic risk factors. Methods The China Cardiometabolic Disease and Cancer Cohort (4C) Study was a nationwide, multicenter, prospective cohort study. About 92,869 participants without cardiovascular disease or cancer at baseline were included. Depression status was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Lifestyle information was collected by the questionnaire, and metabolic risk factors including waist circumference, blood pressure, lipid profiles, and plasma glucose were measured. Major cardiovascular events including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure events were validated based on medical records. Results During an average of 3.8 years of follow-up, we detected 2,076 cardiovascular events and showed that participants with depressive symptoms had an increased risk for cardiovascular events after adjustments [hazard ratio (HR): 1.29; 95% confidence index (CI): 1.08–1.53]. Stratified on metabolic risk status, the relationship between depression and cardiovascular events tended to be stronger according to the increasing numbers of metabolic risk factors, with HR (95% CI) of 0.98 (0.72–1.35) in the category with 0–2 metabolic risk factors, 1.36 (0.996–1.87) and 1.47 (1.13–1.92) for those with 3, and 4–5 metabolic risk factors, respectively, indicating an interaction effect (P = 0.039). Conclusion Depression was independently associated with an increased risk of major cardiovascular events. The effect was particularly prominent among populations at higher metabolic risk.
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Affiliation(s)
- Xi Chen
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Zhelong Liu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Qin Wan
- The Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guixia Wang
- The First Hospital of Jilin University, Changchun, China
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xulei Tang
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yanan Huo
- Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital, Dalian, China
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiajun Zhao
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianshu Zeng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan, China
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading District, Shanghai, China
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Shengli Wu
- Karamay Municipal People’s Hospital, Xinjiang, China
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
- *Correspondence: Xuefeng Yu,
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Weiqing Wang,
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Guang Ning,
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9
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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10
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Gathright EC, Vickery KD, Ayenew W, Whited MC, Adkins-Hempel M, Chrastek M, Carter JK, Rosen RK, Wu WC, Busch AM. The development and pilot testing of a behavioral activation-based treatment for depressed mood and multiple health behavior change in patients with recent acute coronary syndrome. PLoS One 2022; 17:e0261490. [PMID: 35113860 PMCID: PMC8812840 DOI: 10.1371/journal.pone.0261490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with depressed mood demonstrate poor cardiovascular behavioral risk profiles and elevated risk for recurrent ACS and mortality. Behavioral Activation (BA) offers an intervention framework for an integrated treatment targeting both depression and critical health behaviors post-ACS. Behavioral Activation for Health and Depression (BA-HD) was developed and pilot tested in a multiphase iterative process. METHODS First, an initial treatment manual was conceptualized based on the team's prior work, as well as the extant literature. Second, qualitative interviews were conducted with target patients and target providers on the proposed BA-HD treatment rationale, content, and structure. Framework matrix analyses were used to summarize and aggregate responses. Third, an expert panel was convened to elicit additional manual refinements. Finally, patients with post-ACS depression and health behavior non-adherence were recruited to complete an open pilot trial to evaluate acceptability (Client Satisfaction Questionnaire [CSQ], exit interview) and treatment engagement (number of sessions attended; treatment completion was considered completion of 8 out of 10 possible sessions). RESULTS The initial BA-HD treatment manual expanded an existing treatment manual for post-ACS BA-based mood management and smoking cessation to target four health behaviors relevant to post-ACS patients (e.g., smoking cessation, medication adherence, physical activity, and diet). After the initial conceptualization, ten post-ACS patients and eight cardiac rehabilitation professionals completed qualitative interviews. Patients endorsed bi-directional interactions between mood and health behaviors post-ACS. Both patients and providers expressed general support of the proposed treatment rationale and values-guided, collaborative goal-setting approach. Patients, providers, and experts provided feedback that shaped the iterative manual development. After the BA-HD manual was finalized, eight participants were enrolled in a single-arm pilot trial. The mean CSQ score was 30.57 ± 2.23, indicating high satisfaction. Seven out of eight (88%) completed treatment. Pre- to post treatment improvements in depressed mood and health behaviors were promising. CONCLUSIONS BA-HD treatment is an acceptable approach to target both mood and health behaviors in post-ACS patients with depression. A future larger, controlled trial is needed to evaluate the efficacy of the BA-HD treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04158219.
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Affiliation(s)
- Emily C. Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Katherine Diaz Vickery
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Woubeshet Ayenew
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matthew C. Whited
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Jill K. Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Division of Cardiology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
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11
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Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease: Results from the COMETA Multicenter Study. Glob Heart 2021; 16:73. [PMID: 34900564 PMCID: PMC8533660 DOI: 10.5334/gh.1017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To identify associations of anxiety symptoms (AS) and depressive symptoms (DS) with other psychosocial and lifestyle risk factors in primary care patients with arterial hypertension (AH) and/or coronary heart disease (CHD). Methods: COMETA (Clinical-epidemiOlogical prograM of studying psychosocial risk factors in cardiological practice in patiEnts with arterial hyperTension and ischemic heArt disease) is a multicenter cross-sectional study performed in 30 big cities of Russia with two to five out-patient clinics per city randomly selected and two to five general practitioners (GPs) per an out-patient clinic. Each GP included 8–10 consecutive patients with AH and/or CHD. AS and DS were assessed by the Hospital Anxiety and Depression Scale. Results: 325 GPs enrolled 2775 patients (mean age 66.7 years, 72% women) with AH (60.8%), CHD (2.6%), and AH plus CHD (36.6%). Moderate/severe (≥11 HADS) AS were found in 25.5% and DS in 16.3% patients. The strongest associations of AS and DS were revealed for high stress level (OR 5.79; 95% CI [4.18–8.03]), moderate stress level (OR 2.34; 95% CI [1.73–3.16]), low social support (OR 1.87; 95% CI [1.31–2.68]) and female gender (OR 1.78; 95% CI [1.41–2.25]). Low physical activity, unhealthy eating, unemployment and low income were also positively associated with both AS and DS (p < 0.003 for all). Conclusion: In out-patients with AH and CHD, AS and DS were strongly associated with higher levels of stress, low social support, unemployment, low family income and unhealthy lifestyle such as low physical activity, low fruit and vegetables intake and excessive salt consumption. Our findings indicate that patients with AH and CHD, who have anxiety and depressive symptoms need extra attention and monitoring in regard to stress and lifestyle risk factor control.
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12
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Zhang L, Bao Y, Tao S, Zhao Y, Liu M. The association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease: A meta-analysis. Pharmacol Res 2021; 175:106024. [PMID: 34890773 DOI: 10.1016/j.phrs.2021.106024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/27/2021] [Accepted: 12/05/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to investigate the association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease (CVD). This meta-analysis was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42020197839) and conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched to identify all available studies on this topic. Random-effects multivariate meta-regression was performed to investigate the sources of study heterogeneity. Review Manager version 5.3 and Stata 12.0 were used for data analyses. This meta-analysis included 54 studies with a total number of 212,640 patients. Overall, in patients with CVD, aspirin (odds ratio [OR]:0.91, 95% confidence interval [CI]:0.86-0.96, P = 0.02) was associated with a lower risk of depression, while calcium channel blockers (CCB) (OR:1.21, 95%CI:1.05-1.38, P = 0.008), diuretics (OR:1.34, 95%CI:1.14-1.58, P = 0.0005), and nitrate esters (OR:1.32, 95%CI:1.08-1.61, P = 0.006) were associated with a higher risk of depression, additionally, statin (OR:0.79, 95%CI:0.71-0.88, P < 0.0001) was associated with a lower risk of anxiety, but diuretics (OR:1.39, 95%CI:1.26-1.52, P < 0.00001) was associated with a higher risk of anxiety. Subgroup analysis presented that, in patients with hypertension, β-blockers were associated with a higher risk of depression (OR:1.45, 95%CI:1.26-1.67, P < 0.00001); in patients with coronary artery disease (CAD), statin (OR:0.77, 95%CI:0.59-0.99, P = 0.04), and aspirin (OR:0.85, 95%CI:0.75-0.97, P = 0.02) were associated with a lower risk of depression, while CCB (OR:1.32, 95%CI:1.15-1.51, P < 0.0001) and diuretics (OR:1.36, 95%CI:1.12-1.64, P = 0.002) were associated with a higher risk of depression, additionally, diuretics was associated with a higher risk of anxiety (OR:1.41, 95%CI:1.28-1.55, P < 0.00001); in patients with heart failure, nitrate esters (OR:1.93, 95%CI:1.19-3.13, P = 0.007), and diuretics (OR:1.58, 95%CI: 1.02-2.43, P = 0.04) were associated with a higher risk of depression. The use of cardiovascular drugs should be considered when evaluating depression or anxiety in patients with CVD to improve the care and treatment of these patients.
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Affiliation(s)
- Lijun Zhang
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Shuhui Tao
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China; School of Basic Medical Sciences, Henan University, Kaifeng, China.
| | - Yimiao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Meiyan Liu
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
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13
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Yang YL, Leu HB, Yin WH, Tseng WK, Wu YW, Lin TH, Yeh HI, Chang KC, Wang JH, Wu CC, Chen JW. Adherence to healthy lifestyle improved clinical outcomes in coronary artery disease patients after coronary intervention. J Chin Med Assoc 2021; 84:596-605. [PMID: 33871387 DOI: 10.1097/jcma.0000000000000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lifestyle modification is suggested for patients with coronary artery disease (CAD), but the impact of adherence to a healthy lifestyle remains undetermined. The aim of this study is to investigate the association of adherence to a healthy lifestyle with future outcomes and biochemical markers in CAD patients. METHODS The Biosignature CAD study examined 716 CAD patients who underwent a percutaneous coronary intervention (PCI). Information was collected on whether these patients adhered to a healthier lifestyle after PCI, including healthy diet, not smoking, and exercise. The clinical outcomes included major cardiovascular events and unplanned revascularization procedures, hospitalization for refractory or unstable angina, and other causes. RESULTS The average follow-up period was 26.8 ± 8.1 months, during which 175 (24.4%) patients experienced at least one event. The combination of healthy lifestyle factors was associated with lower risk, and the maximum risk reduction reached 50% (hazard ratio: 0.50, 95% confidence interval: 0.25-0.99). As the number of healthy lifestyle factors increased, there were decreases in inflammatory markers, C-reactive protein, waist circumference, low-density lipoprotein cholesterol, and the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (p < 0.05). The benefits of modifiable healthy lifestyle factors were especially observed in the younger population, males, patients with HDL <40 mg/dL, those with reduced left ventricular ejection fraction, and those receiving statin therapy. CONCLUSION Adherence to a healthy lifestyle is independently associated with a lower risk of future adverse events in CAD patients and plays an important role in secondary prevention in the era of interventional cardiology.
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Affiliation(s)
- Ya-Ling Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, ROC
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, ROC
| | - Ji-Hung Wang
- Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan, ROC
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
- Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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14
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Li H, Qian F, Hou C, Li X, Gao Q, Luo Y, Tao L, Yang X, Wang W, Zheng D, Guo X. Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study. J Gerontol A Biol Sci Med Sci 2021; 75:2200-2206. [PMID: 31588954 DOI: 10.1093/gerona/glz228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There remains a relative paucity of evidence for the association between changes in depressive symptoms with cardiovascular disease (CVD) and mortality. This study aimed to evaluate the association of change in depressive symptoms and incident CVD and mortality in a large prospective cohort of middle-aged and older adults. METHODS A total of 6,810 participants free of CVD in the China Health and Retirement Longitudinal Study with two assessments of depressive symptoms at wave 1 (2011-2012) and wave 2 (2013-2014) were included. Elevated depressive symptoms were defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depression scale. We used a modified Poisson regression to examine the association of changes in depressive symptoms (never, onset, remitted, and persistent) and incident CVD (a composite endpoint of heart disease or stroke) and mortality at wave 3 (2015-2016). RESULTS During follow-up, 457 CVDs and 148 deaths occurred. Multivariable analyses revealed that persistent depressive symptoms were associated with an elevated risk of CVD (risk ratio = 1.77, 95% confidence interval = 1.38-2.26) and mortality (risk ratio = 1.63, 95% confidence interval = 1.01-2.64) compared with participants without any depressive symptoms. New-onset depressive symptoms increased the mortality risk (risk ratio = 2.37, 95% confidence interval = 1.52-3.69), but not CVD (risk ratio = 1.15, 95% confidence interval = 0.84-1.58). Remitted depressive symptoms were associated with a 35% and 13% excess risk of CVD and mortality, respectively. CONCLUSION Persistent and remitted depressive symptoms were associated with an increased risk of CVD. New-onset depressive symptoms predicted elevated mortality risk.
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Affiliation(s)
- Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Frank Qian
- Department of Medicine, University of Chicago, Illinois
| | - Chenbei Hou
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Xinghua Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, China
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15
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Dunn SL, Robbins LB, Tintle NL, Collins EG, Bronas UG, Goodyke MP, Luong A, Gutierrez-Kapheim M, DeVon HA. Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID-19 pandemic. Res Nurs Health 2021; 44:279-294. [PMID: 33428224 PMCID: PMC7933089 DOI: 10.1002/nur.22106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 01/19/2023]
Abstract
Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital-based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH-funded randomized controlled trial designed to establish the effectiveness of a 6-week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self-regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID-19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self-management of important PA goals that can contribute to better health outcomes.
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Affiliation(s)
- Susan L Dunn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lorraine B Robbins
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Nathan L Tintle
- Department of Statistics, Dordt University, Sioux Center, Iowa, USA
| | - Eileen G Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ulf G Bronas
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Madison P Goodyke
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anna Luong
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melissa Gutierrez-Kapheim
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
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16
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Mental Health Conditions With Participation in Cardiac Rehabilitation. J Am Heart Assoc 2020; 8:e011639. [PMID: 31115253 PMCID: PMC6585364 DOI: 10.1161/jaha.118.011639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mental health conditions are associated with adverse cardiovascular outcomes in patients with ischemic heart disease, and much of this risk can be attributed to poor health behaviors. Although all patients with ischemic heart disease should be referred for cardiac rehabilitation (CR), whether patients with mental health conditions are willing to participate in CR programs is unknown. We sought to compare CR participation rates among patients with ischemic heart disease with versus without comorbid depression and/or posttraumatic stress disorder (PTSD). Methods and Results We used national electronic health records to identify all patients hospitalized for acute myocardial infarction or coronary revascularization at Veterans Health Administration hospitals between 2010 and 2014. Multivariable logistic regression models were used to determine whether comorbid depression/PTSD was associated with CR participation during the 12 months after hospital discharge. Of the 86 537 patients hospitalized for ischemic heart disease between 2010 and 2014, 24% experienced PTSD and/or depression. Patients with PTSD and/or depression had higher CR participation rates than those without PTSD or depression (11% versus 8%; P<0.001). In comparison to patients without PTSD or depression, the odds of participation was 24% greater in patients with depression alone (odds ratio, 1.24; 95% CI, 1.15–1.34), 38% greater in patients with PTSD alone (odds ratio, 1.38; 95% CI, 1.24–1.54), and 57% greater in patients with both PTSD and depression (odds ratio, 1.57; 95% CI, 1.43–1.74). Conclusions Among patients with ischemic heart disease, the presence of comorbid depression and/or PTSD is associated with greater participation in CR, providing an important opportunity to promote healthy lifestyle behaviors and reduce adverse cardiovascular outcomes among these patients.
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Affiliation(s)
- Nirupama Krishnamurthi
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - David W Schopfer
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Hui Shen
- 3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Mary A Whooley
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
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Sever S, Doherty P, Golder S, Harrison AS. Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics? Open Heart 2020; 7:e001264. [PMID: 32847994 PMCID: PMC7451288 DOI: 10.1136/openhrt-2020-001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR. METHODS Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population. RESULTS The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement. CONCLUSION The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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18
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Park Y, Park YH, Park KS. Determinants of Non-Adherences to Long-Term Medical Therapy after Myocardial Infarction: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103585. [PMID: 32443775 PMCID: PMC7277297 DOI: 10.3390/ijerph17103585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Non-adherence to medications can be classified as unintentional and intentional. The aim of this study was to establish the major determinants of each non-adherence in myocardial infarction (MI). We also evaluated the effects of non-adherences on healthy behaviors. MATERIALS AND METHODS We enrolled 510 patients >1 year after MI. Nonadherences classified as unintentional or intentional were measured by a self-reported questionnaire. Polynomial and multiple regression analysis were performed to evaluate the determinant of each type of nonadherences. RESULTS Among patients with nonadherence, 263 (70.7%) patients were unintentionally non-adherent while 109 (29.3%) patients were intentionally non-adherent. Psychological belief and attitude were important in unintentional non-adherence (Exp(β) = 0.917, p = 0.050 for anxiety; Exp(β) = 1.191, p = 0.001 for concerns). Beliefs about medications were the strongest determinant of intentional non-adherence (Exp(β) = 0.812, p < 0.001 for necessity; Exp(β) = 1.421, p < 0.001 for concerns). Anxiety was important determinant of intentional non-adherence (Exp(β) = 0.889, p = 0.015). CONCLUSION Psychological factors and beliefs about medication were important determinants of both types of non-adherence. Combined approaches targeting the beliefs about medications and psychological distress are needed to improve drug adherence in patients with MI.
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Affiliation(s)
- Yongwhi Park
- Department of Internal Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea;
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea;
| | - Yong-Hwan Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea;
- Department of Cardiology, Samsung Changwon Medical Center, Changwon 51353, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, 15-816 Jinju-daero, Jinju 52727, Korea
- Correspondence: ; Tel.: +82-55-772-8095; +82-55-772-8099
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Jannat-Khah DP, Khodneva Y, Bryant K, Ye S, Richman J, Shah R, Safford M, Moise N. Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants. Ann Epidemiol 2020; 46:31-40.e2. [PMID: 32451197 DOI: 10.1016/j.annepidem.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/30/2020] [Accepted: 04/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (</≥$35,000) moderate the association between TVDS and mortality in a large cohort. METHODS The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models. RESULTS Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]). CONCLUSIONS We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.
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Affiliation(s)
- Deanna P Jannat-Khah
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of Rheumatology, Hospital for Special Surgery, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Yulia Khodneva
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | | | - Siqin Ye
- Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY
| | - Joshua Richman
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Ravi Shah
- Columbia University Medical Center, Psychiatry Faculty Practice Organization, New York, NY
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Nathalie Moise
- Columbia University Medical Center, New York, NY; Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY.
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20
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Yegezu Z, Mollon L, Alshayban DM, Bilal J, Bhattacharjee S. Health-related risk behaviors among myocardial infarction survivors in the United States: A propensity score matched study. Res Social Adm Pharm 2020; 17:307-314. [PMID: 32360124 DOI: 10.1016/j.sapharm.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND According to the American College of Cardiology/the American Heart Association (ACC/AHA) recommendations, health-related risk behaviors for secondary prevention of myocardial infarction (MI) are critical to determine. OBJECTIVE This study aimed to compare health-related risk behaviors between MI survivors and propensity-score-matched non-MI controls using nationally representative data. METHODS This cross-sectional, matched case-control study used publicly available Behavioral Risk Factor Surveillance System (BRFSS) 2017 data. Older adults with MI were propensity-score-matched to their non-MI controls. The 10 dependent variables included body mass index (BMI), smoking status, heavy alcohol consumption, influenza vaccine, length of time since last routine and cholesterol checkup, alcohol consumption, fruit and vegetable consumption, and physical activity. Chi-square tests and binomial logistic regression were used to examine the health-related risk behaviors differences between MI survivors and propensity-score-matched non-MI controls. RESULTS The final study sample consisted of 18,021 MI survivors and 54,063 non-MI controls after propensity score matching. Multivariable logistic regression analysis showed significant differences between MI survivors and matched non-MI controls in terms of cholesterol checkup, smoking status, and alcohol consumption. For example, multivariate analysis of health-related risk behaviors showed MI survivors were more likely to be smokers (AOR = 1.46, 95% CI: 1.28-1.68). CONCLUSION Based on this national survey of adults, MI survivors were more likely to be smokers but less likely to consume alcohol compared to their propensity-score-matched controls. Moreover, MI survivors were more likely to have their cholesterol checkup within the past 2 years compared to matched non-MI controls. Although lower alcohol consumption and greater chances of cholesterol checkups are reassuring health-related behaviors, interventions are needed to minimize the chances of smoking in this population.
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Affiliation(s)
- Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Lea Mollon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Dhafer Mahdi Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Jawad Bilal
- Department of Medicine, Division of Rheumatology, University of Arizona, USA.
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
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Garg PK, O'Neal WT, Diez-Roux AV, Alonso A, Soliman EZ, Heckbert S. Negative Affect and Risk of Atrial Fibrillation: MESA. J Am Heart Assoc 2020; 8:e010603. [PMID: 30563392 PMCID: PMC6405728 DOI: 10.1161/jaha.118.010603] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Current literature examining the prospective relationship between depression and other measures of negative affect with atrial fibrillation (AF) are limited. We determined the relationships of depression, anger, anxiety, and chronic stress with incident AF in a multiethnic cohort of middle‐ and older‐aged adults. Methods and Results This analysis included 6644 MESA (Multi‐Ethnic Study of Atherosclerosis) study participants who were free of AF at baseline. Depressive symptoms were assessed at baseline and defined as either a 20‐item Center for Epidemiologic Studies Depression Scale score ≥16 or use of antidepressant medications. The Spielberger Trait Anger Scale, Spielberger Trait Anxiety Scale, and Chronic Burden Scale were also administered at baseline to assess anger, anxiety, and chronic stress, respectively. The primary outcome was incident AF, identified by follow‐up study visit ECGs, hospital discharge diagnoses, or Medicare claims data. A total of 875 (13%) incident AF cases were detected over a median follow‐up of nearly 13 years. A Center for Epidemiologic Studies Depression Scale score ≥16 (referent, Center for Epidemiologic Studies Depression Scale score <2) and antidepressant use were associated with a 34% and 36% higher risk of AF, respectively, in separate adjusted Cox proportional hazards analyses (hazard ratio, 1.34; 95% CI 1.04–1.74 for Center for Epidemiologic Studies Depression Scale ≥16; hazard ratio, 1.36; 95% CI, 1.04–1.77 for antidepressant use). No significant associations were observed for anger, anxiety, or chronic stress with development of AF. Conclusions Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.
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Affiliation(s)
- Parveen K Garg
- 1 Division of Cardiology University of Southern California Keck School of Medicine Los Angeles CA
| | - Wesley T O'Neal
- 2 Division of Cardiology Emory University School of Medicine Atlanta GA
| | - Ana V Diez-Roux
- 3 Urban Health Collaborative, and Office of Dean Dornsife School of Public Health Drexel University Philadelphia PA
| | - Alvaro Alonso
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Elsayed Z Soliman
- 5 Department of Epidemiology and Prevention Epidemiological Cardiology Research Center (EPICARE) Wake Forest School of Medicine Winston-Salem NC.,6 Section on Cardiology Department of Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Susan Heckbert
- 7 Department of Epidemiology University of Washington Seattle WA
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22
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Medical and Psychosocial Factors Associated With Low Physical Activity and Increasing Exercise Level After a Coronary Event. J Cardiopulm Rehabil Prev 2020; 40:35-40. [DOI: 10.1097/hcr.0000000000000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Nagibina YV, Kubareva MI, Knyazeva DS. Medical and social features of patients with coronary artery disease and depression. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-1930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sever S, Doherty P, Harrison AS, Golder S. To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation? BMC Cardiovasc Disord 2019; 19:256. [PMID: 31726981 PMCID: PMC6857318 DOI: 10.1186/s12872-019-1245-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR. Methods An observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic. Results The analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male. Conclusion The research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Alexander Stephen Harrison
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
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25
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Polanka BM, Berntson J, Vrany EA, Stewart JC. Are Cardiovascular Risk Factors Stronger Predictors of Incident Cardiovascular Disease in U.S. Adults With Versus Without a History of Clinical Depression? Ann Behav Med 2019; 52:1036-1045. [PMID: 30418524 DOI: 10.1093/abm/kay007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Several mechanisms underlying the depression-to-cardiovascular disease (CVD) relationship have been proposed; however, few studies have examined whether depression promotes CVD through potentiating traditional cardiovascular risk factors. Purpose To test the combined influence of three cardiovascular risk factors and lifetime depressive disorder on incident CVD in a large, diverse, and nationally representative sample of U.S. adults. Methods Respondents were 26,840 adults without baseline CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Lifetime depressive disorder, tobacco use, hypertension, and incident CVD were determined from structured interviews, and body mass index (BMI) was computed from self-reported height and weight. Results Logistic regression models predicting incident CVD (1,046 cases) revealed evidence of moderation, as the interactions between lifetime depressive disorder and current tobacco use (p = .002), hypertension (p < .001), and BMI (p = .031) were significant. The Former Tobacco Use × Lifetime Depressive Disorder interaction was not significant (p = .85). In models stratified by lifetime depressive disorder, current tobacco use (OR = 1.78, 95% CI = 1.36-2.32, p < .001 vs. OR = 1.41, 95% CI = 1.24-1.60, p < .001), hypertension (OR = 2.46, 95% CI = 1.98-3.07, p < .001 vs. OR = 1.39, 95% CI = 1.28-1.51, p < .001), and BMI (OR = 1.10, 95% CI = 1.01-1.20, p = .031 vs. OR = 1.03, 95% CI = 0.99-1.07, p = .16) were stronger predictors of incident CVD in adults with versus without a lifetime depressive disorder. Conclusions Our findings suggest that amplifying the atherogenic effects of traditional cardiovascular risk factors may be yet another candidate mechanism that helps to explain the excess CVD risk of people with depression.
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Affiliation(s)
- Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Jessica Berntson
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Elizabeth A Vrany
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Social Support, Unstable Angina, and Stroke as Predictors of Depression in Patients With Coronary Heart Disease. J Cardiovasc Nurs 2019; 33:179-186. [PMID: 28489724 DOI: 10.1097/jcn.0000000000000419] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression is known to adversely affect coronary heart disease patients in western countries; however, no study of social support and depression has been conducted in the Chinese population. OBJECTIVE The aim of this study was to investigate the predictors of depression in patients with coronary heart disease. METHODS Between January and December 2015, a cross-sectional sample of 105 Taiwanese patients from cardiology units completed a demographic and clinical characteristics questionnaire, Enhancing Recovery in Coronary Heart Disease Social Support Inventory, and Patient Health Questionnaire-9. RESULTS Thirty-nine percent of the participants reported low social support, and 61.0% had depression symptoms. Eight factors predicted depression. Social support was significantly and adversely correlated with depression (r = -.481, P < .01). The other 7 factors were positively correlated with depression: age (r = .212, P < .05), reported monthly income of less than US $600 (F = 4.98, P = .001), lack of exercise (F = 3.75, P = .027), history of stroke (t = -2.45, P = .016) and kidney disease (t = -2.41, P = .018), unstable angina (F = 3.56, P = .031), and groin puncture (F = 3.27, P = .042). A hierarchical regression model explained 43.7% of the variance in depression. CONCLUSION Social support, unstable angina, and stroke may be important predictors of depression in patients with coronary heart disease. These findings help clinical staff to understand physical and mental health problems in cardiovascular patients. Thus, we suggest that early depression prediction and sufficient social support can help patients to face their disease and thus improve depression and health care quality.
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27
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Chaihu-Shugan-San and absorbed meranzin hydrate induce anti-atherosclerosis and behavioral improvements in high-fat diet ApoE-/- mice via anti-inflammatory and BDNF-TrkB pathway. Biomed Pharmacother 2019; 115:108893. [DOI: 10.1016/j.biopha.2019.108893] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022] Open
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Schoenthaler A, Fei K, Ramos MA, Richardson LD, Ogedegbe G, Horowitz CR. Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans. J Clin Hypertens (Greenwich) 2019; 21:794-803. [PMID: 31125186 DOI: 10.1111/jch.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D Richardson
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
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Li H, Wang A, Feng W, Zheng D, Gao Q, Tao L, Guo J, Wang X, Li X, Wang W, Guo X. Prospective Study of Glycated Hemoglobin and Trajectories of Depressive Symptoms: The China Health and Retirement Longitudinal Study. Aging Dis 2019; 10:249-257. [PMID: 31011476 PMCID: PMC6457062 DOI: 10.14336/ad.2018.0410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022] Open
Abstract
The longitudinal association between glycated hemoglobin (HbA1c) and different courses of depressive symptoms is understudied. This study aimed to identify different trajectories of depressive symptoms and investigate the relation of HbA1c with the risk of increasing and high-stable depressive symptoms. In the China Health and Retirement Longitudinal Study, depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale in three visits (years: 2011, 2013 and 2015) among 9804 participants (mean age 60.0 ± 9.0 years). Group-based trajectory modeling was used to identify trajectories of depressive symptoms. HbA1c was measured at baseline and categorized five groups according to the respective quintile. Multinomial logistic regression was fitted to examine this relationship. Four distinct trajectories of depressive symptoms were identified: low symptoms (n=6401, 65.29%); decreasing symptoms (n=1362, 13.89%); increasing symptoms (n=1452, 14.81%); and high symptoms (n=1452, 14.81%). Adjusting for demographic, health-related, and cognitive factors, the risk ratio (95% confidence interval) pertaining to the highest HbA1c (Quintile 5) for decreasing, increasing, and high symptoms of depression versus low symptoms was 1.01 (0.82-1.25), 1.12 (0.92-1.36), and 1.39 (1.04-1.86) compared with the lowest HbA1c (Quintile 1), respectively. We observed a J-shaped relationship between HbA1c and high depressive symptoms, with the lowest risk at a HbA1c concentration of 5.0%. In summary, in this large population-based cohort, high levels of glycated hemoglobin concentrations were associated with a higher risk of increasing and high-stable symptoms of depression.
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Affiliation(s)
- Haibin Li
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Anxin Wang
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Wei Feng
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Deqiang Zheng
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Qi Gao
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Lixin Tao
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jin Guo
- 3Greenwood Medical Company, 300 Highway Burwood, Melbourne, Melbourne, Victoria, Australia
| | - Xiaonan Wang
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- 4Department of Mathematics and Statistics, La Trobe University, Victoria, Australia
| | - Wei Wang
- 5Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Xiuhua Guo
- 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
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Cystatin C and risk of new-onset depressive symptoms among individuals with a normal creatinine-based estimated glomerular filtration rate: A prospective cohort study. Psychiatry Res 2019; 273:75-81. [PMID: 30640054 DOI: 10.1016/j.psychres.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 01/09/2023]
Abstract
The association between cystatin C and depressive symptoms in the general population has not been thoroughly elucidated to date. We investigated the association of cystatin C with new-onset depressive symptoms among individuals with normal creatinine-based estimated glomerular filtration rates (eGFR). In the China Health and Retirement Longitudinal Study, 5111 participants without depressive symptoms or renal dysfunction (eGFR < 60 ml/min/1.73 m2) were included. The outcome was new-onset depressive symptoms over 4 years, defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depressive Symptoms Scale. The incidence risk ratio (IRR) and 95% confidence interval (CI) were calculated using modified Poisson regression models. During a 4-year follow-up period, 1746 (34.16%) incidents of depressive symptoms occurred. In a multivariable-adjusted model, the risk of incident depressive symptoms was 1.07 (95% CI 1.02-1.11) per-SD change in cystatin C. A greater cystatin C level was associated with a higher risk of new-onset depressive symptoms among subjects with relatively normal renal function.
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Slater N, Rowley C, Venables RH, White S, Frisher M. Evaluating associations between metabolic health, obesity and depressive symptoms: a prospective analysis of data from the English Longitudinal Study of Ageing (ELSA) with a 2‑year follow‑up. BMJ Open 2018; 8:e025394. [PMID: 30593558 PMCID: PMC6318525 DOI: 10.1136/bmjopen-2018-025394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Conflicting results have been reported when the associations between metabolic health, obesity and depression were examined previously. The primary aim of this study was to determine whether metabolic health or obesity are independently associated with depressive symptoms, among a representative sample of older people living in England. Independent associations between covariates and depression were also examined. DESIGN Prospective study with a 2-year follow-up. SETTING The English Longitudinal Study of Ageing Wave 6 (2012-2013) and Wave 7 (2014-2015). PARTICIPANTS 6804 participants aged older than 50 years. DATA ANALYSIS Multivariate models were used to determine whether metabolic health or obesity are independently associated with depressive symptoms at 2-year follow-up. Unadjusted and adjusted ORs with corresponding 95% CI were calculated; the adjusted ORs took account of baseline depression, gender, age, wealth, obesity and poor metabolic health. RESULTS Before adjusting for covariates, poor metabolic health was associated with depressive symptoms at 2-year follow-up (OR 1.24; 95% CI, 1.07 to 1.44, p<0.01). After adjusting for covariates, the association was no longer statistically significant (OR 1.17; 95% CI, 0.99 to 1.38, p=0.07). Similarly, obesity was associated with depressive symptoms at 2-year follow-up before adjusting for covariates (OR 1.54; 95% CI, 1.33 to 1.79, p<0.01). However, after adjusting for covariates the association between obesity and depressive symptoms at 2-year follow-up became statistically insignificant (OR 1.19; 95% CI, 1.00 to 1.41, p=0.06). The strongest predictors for future depression were baseline depression (OR 10.59; 95% CI, 8.90 to 12.53, p<0.01) and lower wealth (OR 3.23; 95% CI, 2.44 to 4.35, p<0.01). CONCLUSION Neither poor metabolic health nor obesity were associated with a risk of depressive symptoms at 2-year follow-up, after adjusting for covariates. As wealth inequalities continue to rise across England, the risk of depressive symptoms at 2-year follow-up is likely to be elevated in individuals living in the lower wealth quintiles.
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Affiliation(s)
| | | | | | - Simon White
- School of Pharmacy, Keele University, Keele, UK
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Beutel TF, Zwerenz R, Michal M. Psychosocial stress impairs health behavior in patients with mental disorders. BMC Psychiatry 2018; 18:375. [PMID: 30509234 PMCID: PMC6278074 DOI: 10.1186/s12888-018-1956-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It has been shown, that in the general population psychosocial stress affects health behaviors. However similar studies of high risk populations are sparse. Therefore, the aim of this cross-sectional study is to analyze the association between common psychosocial stressors and health behavior in a sample of patients with mental disorders. METHODS We analyzed data of n = 2326 outpatients from a mental health care department. Severity of psychosocial stress was assessed by the PHQ-stress module of the Patient Health Questionnaire (PHQ). Health behaviors included obesity, uncontrolled eating, smoking and physical inactivity. Multiple binary regression models were conducted for the PHQ-stress score and for each of the ten PHQ-stress items as independent variables. RESULTS 'Financial stress' and 'having no one to turn to with problems' were mainly associated with adverse health behaviors after adjustment for multivariate effects. The most affected health behaviors were uncontrolled eating in both sexes and obesity in women. CONCLUSION Our findings indicate specific influences of psychosocial stressors on unhealthy behaviors in a clinical sample. Patients with financial strain and lack of social support might need specific support for improving their health behavior.
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Affiliation(s)
- Till Fabian Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany. .,Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Str. 67, 55131, Mainz, Germany.
| | - Rüdiger Zwerenz
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Deo R, Safford MM, Khodneva YA, Jannat-Khah DP, Brown TM, Judd SE, McClellan WM, Rhodes JD, Shlipak MG, Soliman EZ, Albert CM. Differences in Risk of Sudden Cardiac Death Between Blacks and Whites. J Am Coll Cardiol 2018; 72:2431-2439. [PMID: 30442286 PMCID: PMC9704756 DOI: 10.1016/j.jacc.2018.08.2173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data. OBJECTIVES The purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias. METHODS The Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed. RESULTS Among 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77). CONCLUSIONS In a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.
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Affiliation(s)
- Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yulia A Khodneva
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deanna P Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Todd M Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William M McClellan
- Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J David Rhodes
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Time-dependent depressive symptoms and risk of cardiovascular and all-cause mortality among the Chinese elderly: The Beijing Longitudinal Study of Aging. J Cardiol 2018; 72:356-362. [DOI: 10.1016/j.jjcc.2018.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 12/14/2022]
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Ramirez JL, Drudi LM, Grenon SM. Review of biologic and behavioral risk factors linking depression and peripheral artery disease. Vasc Med 2018; 23:478-488. [DOI: 10.1177/1358863x18773161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The incidence of depression has been rising rapidly, and depression has been recognized as one of the world’s leading causes of disability. More recently, depression has been associated with an increased risk of symptomatic atherosclerotic disease as well as worse perioperative outcomes in patients with cardiovascular disease. Additionally, recent studies have demonstrated an association between depression and peripheral artery disease (PAD), which has been estimated to affect more than 200 million people worldwide. These studies have identified that depression is associated with poor functional and surgical outcomes in patients with PAD. Although the directionality and specific mechanisms underlying this association have yet to be clearly defined, several biologic and behavioral risk factors have been identified to play a role in this relationship. These factors include tobacco use, physical inactivity, medical non-adherence, endothelial and coagulation dysfunction, and dysregulation of the hypothalamic-pituitary-adrenal axis, autonomic system, and immune system. In this article, we review these potential mechanisms and the current evidence linking depression and PAD, as well as future directions for research and interventional strategies. Understanding and elucidating this relationship may assist in preventing the development of PAD and may improve the care that patients with PAD and comorbid depression receive.
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Affiliation(s)
- Joel L Ramirez
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Laura M Drudi
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
- Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, CA, USA
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Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018; 137:2166-2178. [PMID: 29760227 PMCID: PMC5958918 DOI: 10.1161/circulationaha.117.029652] [Citation(s) in RCA: 725] [Impact Index Per Article: 120.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
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Affiliation(s)
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | | | - Jia Shen
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | - Martha Gulati
- University of Arizona-Phoenix College of Medicine (M.G.)
| | - John G Harold
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.G.H.)
| | | | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
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Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study. Ann Behav Med 2017; 50:523-32. [PMID: 26817654 DOI: 10.1007/s12160-016-9777-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emerging evidence indicates that the association between depression and subsequent cardiovascular events is largely mediated by health behaviors. However, it is unclear whether depression is the cause or the consequence of poor health behaviors. PURPOSE The purpose of the present study is to examine prospective, bidirectional relationships of depressive symptoms with behavioral and lifestyle factors among patients with coronary heart disease. METHODS Depressive symptoms and lifestyle behaviors (physical activity, medication adherence, body mass index, waist to hip ratio, sleep quality, and smoking status) were assessed at baseline and 5 years later among a prospective cohort of 667 patients with stable coronary heart disease. RESULTS Greater depressive symptoms at baseline predicted poorer lifestyle behaviors 5 years later (less physical activity, lower medication adherence, higher body mass index, higher waist to hip ratio, worse sleep quality, and smoking). After adjustment for demographics, cardiac disease severity, comorbidity, and baseline lifestyle behaviors, depressive symptom severity remained predictive of subsequent worsening of physical activity (beta = -0.08; 95 % confidence interval (CI) = -0.16, -0.01; p = 0.03), medication adherence (beta = -0.16; 95 % CI = -0.24, -0.08; p < 0.001), and sleep quality (beta = -0.19; 95 % CI = -0.27, -0.11; p < 0.001). Baseline lifestyle behaviors also predicted 5-year change in depressive symptoms, although the associations were attenuated after adjustment for baseline depressive symptoms and covariates. CONCLUSIONS Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence, and sleep quality.
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Impact of Home- and Hospital-Based Exercise in Cardiac Rehabilitation on Hopelessness in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2017; 37:39-48. [PMID: 27676463 DOI: 10.1097/hcr.0000000000000205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). The purpose of this research was to examine the effect of regular home- and hospital-based cardiac rehabilitation (CR) exercise on hopelessness levels in patients with CHD, hypothesizing that increased exercise in either setting would lead to decreased state hopelessness. METHODS A descriptive longitudinal design was used at a large teaching hospital in Michigan. A total of 324 patients provided data during hospitalization and at least 1 followup time point (3, 8, and 12 months). RESULTS The patients had persistent, modest levels of state and trait hopelessness across all time points. Among home exercisers with moderate to severe state hopelessness at baseline, both mean state (P = .002) and trait (P = .02) hopelessness were reduced at later time points compared with those who quit or did not start exercise. Multivariable models showed that when individuals had moderate to severe baseline state hopelessness, home exercise remained associated with decreases in state hopelessness compared with no exercise, even after adjusting for hospital exercise, depression, and demographic variables. CONCLUSIONS Exercise may be effective in reducing moderate to severe hopelessness in patients with CHD. Moderate to severe baseline state hopelessness was a predictor of attrition in this cohort, especially for home exercisers, but this was mediated in hospital-based programs. Further research is needed to determine how hopeless individuals can be encouraged to exercise and whether home- or a hospital-based CR exercise is superior in impacting hopelessness.
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Genetic and Environmental Relationships Between Depressive and Anxiety Symptoms and Cardiovascular Risk Estimates Among Korean Twins and Families. Twin Res Hum Genet 2017; 20:533-540. [PMID: 28978361 DOI: 10.1017/thg.2017.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We aimed to assess shared genetic correlations of depressive and anxiety symptoms with concurrent and future estimated cardiovascular risk (CVR) score in Korean twins and family members. For the relationship with Adult Treatment Panel III CVR estimate in subjects aged 30-74 years (n = 1,059, baseline and follow-up after 3.2 ± 1.2 years), Center for Epidemiological Studies Depression Scale (CES-D) and state and trait anxiety inventory (SAI and TAI) were measured at baseline. A mixed linear model for CVR scores at baseline and follow-up was applied to include depressive and anxiety symptoms, twin and family effects, income, education, alcohol use, exercise, body mass index, and baseline CVR score for follow-up analysis. Higher CES-D scores were associated with higher CVR score at baseline in men, while higher TAI score was associated with higher CVR score at follow-up in women. Heritabilities were 0.245~0.326 for CVR score, 0.320 for CES-D score, 0.367 for TAI score, and 0.482 for SAI score. There were significant common genetic correlations in the relationships of CES-D, TAI, and SAI scores with CVR scores at baseline and follow-up (after adjusting for baseline CV risk score). Shared common environmental correlations were observed in the relationships of CES-D and SAI scores with CVR score at baseline; and SAI score with CVR score at follow-up. In the within-monozygotic twin analysis, there were no associations between CES-D, TAI, and SAI scores, and CVR score. In conclusion, shared genetic and environmental influences were observed in the relationship between depressive and anxiety symptoms with concurrent and future CVR estimates.
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Lee SK, Khambhati J, Varghese T, Stahl EP, Kumar S, Sandesara PB, Wenger NK, Sperling LS. Comprehensive primary prevention of cardiovascular disease in women. Clin Cardiol 2017; 40:832-838. [PMID: 28846803 DOI: 10.1002/clc.22767] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/02/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in women. Historically, medical research has focused on male patients, and subsequently, there has been decreased awareness of the burden of ASCVD in females until recent years. The biological differences between sexes and differences in societal expectations defined by gender roles contribute to gender differences in ASCVD risk factors. With these differing risk profiles, risk assessment, risk stratification, and primary preventive measures of ASCVD are different in women and men. In this review article, clinicians will understand the risk factors unique to women, such as preeclampsia, gestational diabetes, and those that disproportionately affect them such as autoimmune disorders. With these conditions in mind, the approach to ASCVD risk assessment and stratification in women will be discussed. Furthermore, the literature behind the effects of primary preventive measures in women, including lifestyle modifications, aspirin, statins, and anticoagulation, will be reviewed. The aim of this review article was to ultimately improve ASCVD primary prevention by reducing gender disparities through education of physicians.
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Affiliation(s)
- Suegene K Lee
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Tina Varghese
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Eric P Stahl
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Sonali Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia
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Abstract
The analytical paper summarized the results of recent studies of an association of depression, anxiety, and stress with coronary heart disease (CHD). Mental disorders are shown to be associated with increased risk of CHD and to worsen the course of coronary disease. Antidepressants and psychotherapy improve the control of mental disorders, quality of life, and, in some cases, have a positive impact on the course of coronary disease.
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Abstract
OBJECTIVE Depression is an independent risk factor for cardiac events and mortality in individuals with or without cardiovascular disease (CVD), although the underlying mechanisms involved in sudden cardiac death (SCD) and arrhythmias remain unclear. This meta-analysis aimed to assess the relationship between depression and risk of SCD and arrhythmias. METHODS We systematically searched MEDLINE, Elsevier, and PsycINFO databases for articles (January 1990 to June 2015) describing the correlation of depression ("depressive symptoms," "depression," or "depressive disorder") with SCD or arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF], or atrial fibrillation [AF]). Data were meta-analyzed with random-effects models. RESULTS A total of 17 studies met the inclusion criteria: 4 of SCD (n = 83,659), 8 of VT/VF (n = 4,048), and 5 of AF (n = 31,247). The total sample consisted of 8,533 individuals with and 110,421 individuals without previous CVD. Depression was associated with increased risk of SCD (hazard risk [HR], 1.62; 95% confidence interval [CI], 1.37-1.92; p < .001), VT/VF (HR, 1.47; 95% CI, 1.23-1.76; p < .001) and AF recurrence (HR, 1.88; 95% CI, 1.54-2.30; p < .001). There was no significant association, however, between depression and risk of new-onset AF (HR, 0.96; 95% CI, 0.87-1.04; p = .311). CONCLUSIONS Depression (clinical depression and depressive symptoms) is associated with increased risk of SCD, VT/VF, and AF recurrence. These findings suggest that arrhythmias play an important role in the association between depression and increased mortality in individuals with or without CVD. Systematic evaluation and treatment of depression may contribute to the prevention of lethal cardiac events in the general population and in high-risk individuals with CVD.
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Dog Ownership and Dog Walking: The Relationship With Exercise, Depression, and Hopelessness in Patients With Ischemic Heart Disease. J Cardiovasc Nurs 2017; 33:E7-E14. [PMID: 28489725 DOI: 10.1097/jcn.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dog ownership has been associated with increased physical activity in the general adult population. OBJECTIVE The objective of this study was to examine dog ownership and dog walking and their relationship with home-based and phase II cardiac rehabilitation exercise, depression, and hopelessness in patients with ischemic heart disease. METHODS A total of 122 patients with ischemic heart disease were included in this prospective observational study. Patients completed dog ownership/walking questions during their hospitalization. The Cardiac Rehabilitation Exercise Participation Tool, Patient Health Questionnaire-9, and State-Trait Hopelessness Scale were completed by mail at 3, 8, or 12 months later. Regression modeling was used to evaluate the significance of dog ownership/walking on exercise, depression and hopelessness. RESULTS The sample was 34.4% female and had a mean age of 64.7 ± 9.1 years. Forty-two patients (34.4%) reported owning a dog. Patients who owned but did not walk their dog reported significantly lower levels of home exercise compared with patients who walked their dogs at least 1 day per week (36.8% for non-dog walkers vs 73.9% for dog walkers, P = .019). The odds of participating in home exercise were significantly higher for dog walkers compared with non-dog walkers (odds ratio, 8.1 [1.7, 38.5] vs 1.0). There were no differences in phase II cardiac rehabilitation exercise, depression, or hopelessness between dog owners and non-dog owners or between dog walkers and non-dog walkers. CONCLUSIONS These findings show a beneficial effect on home-based exercise for those who dog-walk at least 1 day per week. Healthcare professionals should encourage dog walking to increase dog owners' physical activity levels.
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Fujiwara N, Tanaka A, Kawaguchi A, Tago M, Oyama JI, Uchida Y, Matsunaga K, Moroe K, Toyoda S, Inoue T, Ikeda H, Node K. Association Between Blood Pressure Lowering and Quality of Life by Treatment of Azilsartan. Int Heart J 2017; 58:752-761. [DOI: 10.1536/ihj.16-511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Motoko Tago
- Department of Cardiovascular Medicine, Saga University
| | | | | | | | - Kazuo Moroe
- Department of Cardiovascular Medicine, Moroe Cardiovascular Clinic
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | - Hideo Ikeda
- Department of Internal Medicine, Ikeda Naika Hifuka Clinic
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Rahe C, Khil L, Wellmann J, Baune BT, Arolt V, Berger K. Impact of major depressive disorder, distinct subtypes, and symptom severity on lifestyle in the BiDirect Study. Psychiatry Res 2016; 245:164-171. [PMID: 27543830 DOI: 10.1016/j.psychres.2016.08.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/28/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine associations of major depressive disorder (MDD), its distinct subtypes, and symptom severity with the individual lifestyle factors smoking, diet quality, physical activity, and body mass index as well as with a combined lifestyle index measuring the co-occurrence of these lifestyle factors. A sample of 823 patients with MDD and 597 non-depressed controls was examined. The psychiatric assessment was based on a clinical interview including the Mini International Neuropsychiatric Interview and the Hamilton Depression Rating Scale. Each lifestyle factor was scored as either healthy or unhealthy, and the number of unhealthy lifestyle factors was added up in a combined lifestyle index. Cross-sectional analyses were performed using alternating logistic regression and ordinal logistic regression, adjusted for socio-demographic characteristics. After adjustment, MDD was significantly associated with smoking, low physical activity, and overweight. Likewise, MDD was significantly related to the overall lifestyle index. When stratifying for subtypes, all subtypes showed higher odds for an overall unhealthier lifestyle than controls, but the associations with the individual lifestyle factors were partly different. Symptom severity was associated with the lifestyle index in a dose-response manner. In conclusion, patients with MDD represent an important target group for lifestyle interventions.
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Affiliation(s)
- Corinna Rahe
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Laura Khil
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Sumner JA, Khodneva Y, Muntner P, Redmond N, Lewis MW, Davidson KW, Edmondson D, Richman J, Safford MM. Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low- and High-Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study. J Am Heart Assoc 2016; 5:JAHA.116.003930. [PMID: 27792645 PMCID: PMC5121497 DOI: 10.1161/jaha.116.003930] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all‐cause mortality as a function of socioeconomic status. Methods and Results At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician‐adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all‐cause mortality over a median of 7.0 years (interquartile range 5.4–8.3 years) of follow‐up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21–1.81) and all‐cause mortality (hazard ratio 1.33, 95% CI 1.13–1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education. Conclusions Findings suggest that screening for a combination of elevated depressive symptoms and stress in low‐income persons may help identify those at increased risk of incident CVD and mortality.
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Affiliation(s)
- Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Nicole Redmond
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Marquita W Lewis
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Joshua Richman
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, AL
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
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47
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Gulati M, Buffomante AA, Wenger NK. Depression and Anxiety in Women with Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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48
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Gall SL, Sanderson K, Smith KJ, Patton G, Dwyer T, Venn A. Bi-directional associations between healthy lifestyles and mood disorders in young adults: The Childhood Determinants of Adult Health Study. Psychol Med 2016; 46:2535-2548. [PMID: 27338017 DOI: 10.1017/s0033291716000738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthy lifestyles prevent cardiovascular disease and are increasingly recognized in relation to mental health but longitudinal studies are limited. We examined bi-directional associations between mood disorders and healthy lifestyles in a cohort followed for 5 years. METHOD Participants were aged 26-36 years at baseline (2004-2006) and 31-41 years at follow-up (2009-2011). At follow-up, lifetime mood disorders (depression or dysthymia) were retrospectively diagnosed with the Composite International Diagnostic Interview. A five-item lifestyle score (comprising body mass index, non-smoking, alcohol consumption, leisure time physical activity and healthy diet) was measured at both time points. Linear and log multinomial regression determined if mood disorder before baseline predicted changes in lifestyle (n = 1041). Log binomial regression estimated whether lifestyle at baseline predicted new episodes of mood disorder (n = 1233). Covariates included age, sex, socio-economic position, parental and marital status, social support, major life events, cardiovascular disease history, and self-rated physical and mental health. RESULTS A history of mood disorder before baseline predicted unfavourable trajectories of lifestyle over follow-up, including somewhat lower risk of improvement [relative risk (RR) 0.76, 95% confidence interval (CI) 0.56-1.03] and greater risk of worsening (RR 1.46, 95% CI 0.99-2.15) of lifestyle independent of confounding factors. Higher lifestyle scores at baseline were associated with a 22% (RR 0.76, 95% CI 0.61-0.95) reduced risk of first episodes of mood disorder, independent of confounding factors. CONCLUSIONS Healthy lifestyles and mood disorders are closely related. Our results suggest that healthy lifestyles may not only reduce cardiovascular disease but also promote mental health.
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Affiliation(s)
- S L Gall
- University of Tasmania,Menzies Institute for Medical Research,Hobart,TAS,Australia
| | - K Sanderson
- University of Tasmania,Menzies Institute for Medical Research,Hobart,TAS,Australia
| | - K J Smith
- University of Tasmania,Menzies Institute for Medical Research,Hobart,TAS,Australia
| | - G Patton
- Murdoch Children's Research Institute,Centre for Adolescent Health,Parkville,VIC,Australia
| | - T Dwyer
- University of Tasmania,Menzies Institute for Medical Research,Hobart,TAS,Australia
| | - A Venn
- University of Tasmania,Menzies Institute for Medical Research,Hobart,TAS,Australia
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49
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Ski CF, Worrall-Carter L, Cameron J, Castle DJ, Rahman MA, Thompson DR. Depression screening and referral in cardiac wards: A 12-month patient trajectory. Eur J Cardiovasc Nurs 2016; 16:157-166. [DOI: 10.1177/1474515115583617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Linda Worrall-Carter
- St Vincent’s Centre for Nursing Research, Australian Catholic University, Melbourne, Australia
| | - Jan Cameron
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
| | - David J Castle
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Muhammad A Rahman
- St Vincent’s Centre for Nursing Research, Australian Catholic University, Melbourne, Australia
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
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50
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Arbel Y, FitzGerald G, Yan AT, Tan MK, Fox KAA, Gore JM, Steg PG, Eagle KA, Brieger D, Montalescot G, Budaj A, Lopez-Sendon J, Avezum A, Granger CB, Goodman SG. Temporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary Events. Int J Cardiol 2016; 218:291-297. [PMID: 27240154 DOI: 10.1016/j.ijcard.2016.05.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Yaron Arbel
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gordon FitzGerald
- Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA
| | - Andrew T Yan
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mary K Tan
- Canadian Heart Research Centre, Toronto, Canada
| | - Keith A A Fox
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France
| | - Kim A Eagle
- Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - David Brieger
- Concord Hospital and University of Sydney, Sydney, Australia
| | - Gilles Montalescot
- Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
| | - Andrzej Budaj
- Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Jose Lopez-Sendon
- Hospital Universitario La Paz, Instituto de Investigación La PAZ, Madrid, Spain
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology and University of Santo Amaro, São Paulo, SP, Brazil
| | | | - Shaun G Goodman
- St. Michael's Hospital, University of Toronto, Toronto, Canada; Canadian Heart Research Centre, Toronto, Canada.
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