Associations of cardiovascular disease and depression with memory related disease: A Chinese national prospective cohort study

The influence of Life's Essential 8 on the link between socioeconomic status and depression in adults: a mediation analysis

BACKGROUND

Individuals with low socioeconomic status (SES) are at a higher risk of developing depression. However, evidence on the role of cardiovascular health (CVH) in this chain is sparse and limited. The purpose of this research was to assess the mediating role of Life's Essential 8 (LE8), a recently updated measurement of CVH, in the association between SES and depression according to a nationally representative sample of adults.

METHODS

Data was drawn from the National Health and Nutrition Examination Survey (NHANES) in 2013-2018. Multivariate logistic regression analysis was applied to analyze the association of SES (measured via the ratio of family income to poverty (FIPR), occupation, educational level, and health insurance) and LE8 with clinically relevant depression (CRD) (evaluated using the Patient Health Questionnaire (PHQ-9)). Multiple linear regression analysis was performed to analyze the correlation between SES and LE8. Mediation analysis was carried out to explore the mediating effect of LE8 on the association between SES and CRD. Moreover, these associations were still analyzed by sex, age, and race.

RESULTS

A total of 4745 participants with complete PHQ-9 surveys and values to calculated LE8 and SES were included. In the fully adjusted model, individuals with high SES had a significantly higher risk of CRD (odds ratio = 0.21; 95% confidence interval: 0.136 to 0.325, P < 0.01) compared with those with low SES. Moreover, LE8 was estimated to mediate 22.13% of the total association between SES and CRD, and the mediating effect of LE8 varied in different sex and age groups. However, the mediating effect of LE8 in this chain was significant in different sex, age, and racial subgroups except for Mexican American (MA) individuals.

CONCLUSION

The results of our study suggest that LE8 could mediate the association between SES and CRD. Additionally, the mediating effect of LE8 in this chain could be influenced by the race of participants.

Eight-year trajectories and predictors of cognitive function in community-dwelling Korean older adults with cardiovascular diseases

PURPOSE

This study aims to identify longitudinal patterns and predictors of cognitive function trajectories among Korean older adults with cardiovascular diseases.

DESIGN

This study is a longitudinal panel analysis based on secondary data. Data from the the Korean Longitudinal Study of Ageing (KLoSA) were used for analysis.

METHODS

The KLoSA is a representative panel survey of older Koreans. We analyzed responses from 301 participants aged ≥65 years who completed the same survey more than three times out of five waves between 2012 and 2020.

FINDINGS

Latent class growth modeling identified two trajectories of cognitive function in older people with cardiovascular diseases: "low and declining" (n = 81, 26.9%) and "high and declining" (n = 220, 73.1%). Participants in "the low and declining trajectory group" were more likely to have a low educational level, weak handgrip strength, depression, and low social participation at baseline than those in "the high and declining trajectory group."

CONCLUSIONS

Our results indicate a need to develop community-based tailored interventions for improving handgrip strength, mental health, and social participation in delaying cognitive decline in older people with cardiovascular diseases considering their educational level.

CLINICAL RELEVANCE

Healthcare providers should be more concerned about older people with a weaker handgrip, depression, and low social activities as a high-risk group for cognitive decline over time in cardiovascular care. Therefore, it is necessary to evaluate them early with standardized tools and make subsequent strategies for the older population with cardiovascular diseases.

Exploring the multiverse: the impact of researchers' analytic decisions on relationships between depression and inflammatory markers

In recent years, a replication crisis in psychiatry has led to a growing focus on the impact of researchers' analytic decisions on the results from studies. Multiverse analyses involve examining results across a wide array of possible analytic decisions (e.g., log-transforming variables, number of covariates, or treatment of outliers) and identifying if study results are robust to researchers' analytic decisions. Studies have begun to use multiverse analysis for well-studied relationships that have some heterogeneity in results/conclusions across studies.We examine the well-studied relationship between peripheral inflammatory markers (PIMs; e.g., white blood cell count (WBC) and C-reactive protein (CRP)) and depression severity in the large NHANES dataset (n = 25,962). Specification curve analyses tested the impact of 9 common analytic decisions (comprising of 58,000+ possible combinations) on the association of PIMs and depression severity. Relationships of PIMs and total depression severity are robust to analytic decisions (based on tests of inference jointly examining effect sizes and p-values). However, moderate/large differences are noted in effect sizes based on analytic decisions and the majority of analyses do not result in significant findings, with the percentage of analyses with statistically significant results being 46.1% for WBC and 43.8% for CRP. For associations of PIMs with specific symptoms of depression, some associations (e.g., sleep, appetite) in males (but not females) were robust to analytic decisions. We discuss how multiverse analyses can be used to guide research and also the need for authors, reviewers, and editors to incorporate multiverse analyses to enhance replicability of research findings.

Long-term trajectories of depressive symptoms and machine learning techniques for fall prediction in older adults:Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Falls are the most common adverse outcome of depression in older adults, yet a accurate risk prediction model for falls stratified by distinct long-term trajectories of depressive symptoms is still lacking.

METHODS

We collected the data of 1617 participants from the China Health and Retirement Longitudinal Study register, spanning between 2011 and 2018. The 36 input variables included in the baseline survey were regarded as candidate features. The trajectories of depressive symptoms were classified by the latent class growth model and growth mixture model. Three data balancing technologies and four machine learning algorithms were utilized to develop predictive models for fall classification of depressive prognosis.

RESULTS

Depressive symptom trajectories were divided into four categories, i.e., non-symptoms, new-onset increasing symptoms, slowly decreasing symptoms, and persistent high symptoms. The random forest-TomekLinks model achieved the best performance among the case and incident models with an AUC-ROC of 0.844 and 0.731, respectively. In the chronic model, the gradient boosting decision tree-synthetic minority oversampling technique obtained an AUC-ROC of 0.783. In the three models, the depressive symptom score was the most crucial component. The lung function was a common and significant feature in both the case and the chronic models.

CONCLUSIONS

This study suggests that the ideal model has a good chance of identifying older persons with a high risk of falling stratified by long-term trajectories of depressive symptoms. Baseline depressive symptom score, lung function, income, and injury experience are influential factors associated with falls of depression evolution.

The mediating effect of depression on new-onset stroke in diabetic population: Evidence from the China health and retirement longitudinal study

BACKGROUND

Diabetes has a high incidence in China, which may cause stroke and depression. However, the relationship between diabetes and the incidence of new-onset stroke and depression has not been fully studied.

METHODS

The data from the China Longitudinal Study on Health and Retirement (CHARLS) from 2013 to 2018 were used. A total of 8530 respondents aged ≥45 years old were included in the follow-up study. Logistic regression model, Cox regression, and Mediation analyses were used to explore the association between diabetes, depression, and new-onset stroke.

RESULTS

The depression score of patients with diabetes history was higher (HR,95%CI = 1.02, 1.01-1.04) and were more likely to experience new-onset stroke events (HR, 95%CI = 1.046, 1.02-1.07). With a history of hypertension (HR,95%CI = 1.747, 1.381-2.208), older (HR,95%CI = 1.033, 1.020-1.046) with high BMI (HR,95%CI = 1.056, 1.027-1.086) have a high risk of new-onset stroke. In the combined subgroup analysis, the incidence of new-onset stroke in the subgroup with diabetes depression was higher than in others. The mediating effect of depression on new-onset stroke events in diabetic patients is more pronounced in the medium to long term (>3 years) after adjusting covariates.

LIMITATIONS

We defined new-onset stroke by patient self-report, there might be some memory bias. In addition, new-onset stroke was not classified in the CHARLS questionnaire, which would hinder us to evaluate the mediating effect of depression on different types of new-onset stroke.

CONCLUSION

Our results showed that depression has a partial mediating effect between diabetes and new-onset stroke in the middle-aged and elderly population in China.

Prospective bidirectional associations between depression and chronic kidney diseases

Previous studies had reported the mutual relation between depression and chronic kidney diseases (CKD). This study aimed to investigate potential bidirectional relationships between depression and CKD. Participants more than 45 years from the China Health and Retirement Longitudinal Study (CHARLS) were included in present study. In study I, we tended to assess the association between baseline depression with the risk of subsequent CKD. In study II, we aimed to examine whether the onset of CKD could predict the development of depression. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) in study I and study II, respectively. In study I, 301 (6.16%) respondents experienced CKD in participants without depression, and 233 (8.48%) respondents experienced CKD in participants with depression. Participants with depression had higher risk of developing CKD with the corresponding ORs (95% CIs) was 1.38(1.08-1.76). In study II, 1333 (22.29%) subjects in the non-CKD group and 97 (27.17%) in CKD group developed depressive symptoms. Individuals with CKD had higher risk of developing depression than those without CKD, with the multivariate ORs (95% CIs) was 1.48(1.23-1.78). Significant bidirectional relationships remained in both sensitivity and subgroup analyses. Findings demonstrate bidirectional relationships between depression and CKD. Individuals with depression were associated with increasing risk of CKD; in addition, CKD patients had higher risk of developing depression.

Effects of the Lipid Metabolites and the Gut Microbiota in ApoE−/− Mice on Atherosclerosis Co-Depression From the Microbiota-Gut-Brain Axis

Background: The diagnosis, treatment, and prevention of atherosclerosis co-depression are poor, so it is urgent to explore new targets. Based on the “microbiota-gut-brain axis,” this study aimed to investigate the changes of lipid metabolites in the prefrontal cortex and hippocampus regions and the characteristics of the gut microbiota in ApoE−/− mice with atherosclerosis co-depression.

Methods: ApoE−/− mice (hyperlipid feeding combined with binding, HFB group, n = 14, male) fed a high-fat diet for 16 weeks with binding stimulation were used as an animal model for atherosclerosis co-depression. The depression degree of mice was evaluated by body weight, sucrose preference test, open field test, and tail suspension test. Oil-red O staining, HE staining, and biochemical parameters were used to evaluate the damage degree of atherosclerosis in mice. LC-MS/MS technique for non-targeted lipidomics analysis was used to analyze the differential lipid metabolites in the prefrontal cortex and hippocampus regions of mice. 16S rDNA amplification sequencing was used to screen the differential gut microbial, and association analysis was performed with the differential lipid metabolites.

Results: Compared with the normal control group (NC group), the HFB group showed depression-like behaviors and atherosclerosis-related pathological indicators. The differential lipid metabolites in the prefrontal cortex and hippocampus regions were mainly LPC, LPE, LPS, PC, PE, PS, PI, and GD1a, and were mainly enriched in the glycerophospholipid metabolism pathway and the retrograde endocannabinoid signaling pathway. At the same time, there were significant differences in the structure of the gut microbial community between the two groups. The abundance of Deferribacteres and Proteobacteria in the HFB group increased, while the abundance of Verrucomicrobia and Actinobacteria decreased at the phylum level; the abundance of Desulfovibrio, Clostridium_IV, Helicobacter and Pseudoflavonifractor increased, while the abundance of Akkermansia decreased at the genus level.

Conclusion: Atherosclerosis co-depression of ApoE−/− mice of the prefrontal cortex and hippocampus lipid metabolism pathways of disorder and the changes of to the gut microbiota, which leads to abnormal white matter and synaptic dysfunction, increased gut inflammation, and decreased gut permeability, leading to the release of inflammatory cytokines, there is a strong correlation between both, it further confirmed the existence of the “microbiota-gut-brain axis.”

The Efficacy of Double-Heart Nursing in Combination with Seaweed Polysaccharide for Patients with Coronary Heart Disease Complicated with Diabetes: A Pilot, Randomized Clinical Trial

Objective

To study and explore the effect of double-heart nursing combined with seaweed polysaccharide on improving the self-efficacy and quality of life of patients with coronary heart disease and diabetes.

Methods

Eligible 214 patients with coronary heart disease and diabetes who were diagnosed and treated in our hospital between year 2017 and 2020 were randomized at a ratio of 1 : 1 to either control group (seaweed polysaccharide) or observation group (double-heart nursing combined with seaweed polysaccharide). The self-efficacy and quality of life of the two groups of patients after treatment were compared.

Results

The observation group reported a lower blood glucose level after treatment vs. the control group [(6.28 ± 4.49/8.24 ± 2.01) vs. (7.74 ± 4.18/11.41 ± 3.12)] (p < 0.05); a lower incidence of lesions in the observation group versus the control group after treatment (p < 0.05); and significantly lower SAS and SDS scores of the observation group vs. the control group was observed [(41.27 ± 4.08/43.81 ± 2.93) vs. (62.74 ± 3.48/61.58 ± 3.85)] (p < 0.05). Regarding the self-efficacy, the observation group was superior to the control group after treatment (p < 0.05). The treatment with double-heart nursing combined with seaweed polysaccharide was associated with the improvement of the quality of life with respect to social function, psychological function, and material life (each p < 0.05). The observation obtained a significantly higher satisfaction rate in comparison with the control group [107 (98.13%) vs.95 (88.80%)] (p < 0.05).

Conclusion

Seaweed polysaccharide and double-heart nursing might be practical in improving the self-efficacy and quality of life of patients with coronary heart disease and diabetes mellitus, compared with conventional clinical treatment alone.

Determinants of self-rated health among an older Tibetan population in a Chinese plateau area: analysis based on the conceptual framework for determinants of health

BACKGROUND

Self-rated health (SRH) has been frequently used in population health surveys. However, most of these studies only focus on specific factors that might directly affect SRH, so only partial or confounding information about the determinants of SRH is potentially obtained. Conducted in an older Tibetan population in a Chinese plateau area, the aim of our study is to assess interrelationships between various factors affecting SRH based on the conceptual framework for determinants of health.

METHODS

Between May 2018 and September 2019, 2707 Tibetans aged 50 years or older were recruited as part of the China Multi-Ethnic Cohort Study (CMEC) from the Chengguan District of Lhasa city in Tibet. The information included SRH and variables based on the conceptual framework for determinants of health (i.e., socioeconomic status, health behaviors, physical health, mental health, and chronic diseases). Structural equation modeling (SEM) was used to estimate the direct and indirect effects of multiple factors in the conceptual framework.

RESULTS

Among all participants, 5.54% rated their health excellent, 51.16% very good, 33.58% good, 9.12% fairly poor and 0.59% poor. Physical health (β = - 0.23, P <  0.001), health behaviors (β = - 0.44, P <  0.001), socioeconomic status (β = - 0.29, P <  0.001), chronic diseases (β = - 0.32, P <  0.001) and gender (β = 0.19, P <  0.001) were directly associated with SRH. Socioeconomic status, physical health and gender affected SRH both directly and indirectly. In addition, there are potential complete mediator effects in which age and mental health affect SRH through mediators, such as physical health, health behaviors and chronic diseases.

CONCLUSIONS

The findings suggested that interventions targeting behavioral changes, health and chronic disease management should be attached to improve SRH among older populations in plateau areas without ignoring gender and socioeconomic disparities.

Combined effect of high depressive symptom burden and hypertension on new-onset stroke: evidence from a nationwide prospective cohort study

OBJECTIVE

The aim of this study was to investigate whether the combination of high depressive symptom burden and hypertension increased the risk of stroke among the middle-aged and elderly Chinese using a nationwide prospective study.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011-2015 were used. A total of 12 604 Chinese participants aged 45 years and older were included for final analysis. Multivariate Cox proportional hazards regression model was used to explore the associations between high depressive symptom burden, hypertension and new-onset stroke.

RESULTS

There were 244 stroke events occurred during a 4-year follow-up. Compared with those without high depressive symptom burden and hypertension, the adjusted hazard ratios (95% confidence intervals) were 1.96 (1.13-3.42) for individuals with high depressive symptom burden alone, 2.84 (1.77-4.57) for individuals with hypertension alone and 4.38 (2.66-7.20) for individuals with comorbid high depressive symptom burden and hypertension, respectively. In the subgroup analyses, people with the coexistence of high depressive symptom burden and hypertension had the highest risk of new-onset stroke in all subgroups.

CONCLUSION

Our results suggest a combined effect of high depressive symptom burden and hypertension on stroke risk among the middle-aged and elderly Chinese.