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McDermott MM, Ho KJ, Alabi O, Criqui MH, Goodney P, Hamburg N, McNeal DM, Pollak A, Smolderen KG, Bonaca M. Disparities in Diagnosis, Treatment, and Outcomes of Peripheral Artery Disease: JACC Scientific Statement. J Am Coll Cardiol 2023; 82:2312-2328. [PMID: 38057074 DOI: 10.1016/j.jacc.2023.09.830] [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: 06/21/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023]
Abstract
Disparities by sex, race, socioeconomic status, and geography exist in diagnosis, treatment, and outcomes for people with lower extremity peripheral artery disease (PAD). PAD prevalence is similar in men and women, but women have more atypical symptoms and undergo lower extremity revascularization at older ages compared to men. People who are Black have an approximately 2-fold higher prevalence of PAD, compared to people who are White and have more atypical symptoms, greater mobility loss, less optimal medical care, and higher amputation rates. Although fewer data are available for other races, people with PAD who are Hispanic have higher amputation rates than White people. Rates of amputation also vary by geography in the United States, with the highest rates of amputation in the southeastern United States. To improve PAD outcomes, intentional actions to eliminate disparities are necessary, including clinician education, patient education with culturally appropriate messaging, improved access to high-quality health care, science focused on disparity elimination, and health policy changes.
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Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Karen J Ho
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Olamide Alabi
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael H Criqui
- University of California-San Diego, School of Medicine, La Jolla, California, USA
| | - Philip Goodney
- Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | | | - Demetria M McNeal
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Pollak
- Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Kim G Smolderen
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc Bonaca
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Welch KG, Faria I, Browder SE, Drudi LM, McGinigle KL. Depression in Patients with Peripheral Artery Disease: An Underdiagnosis with Increased Mortality. Ann Vasc Surg 2023; 95:80-86. [PMID: 36948397 PMCID: PMC10866090 DOI: 10.1016/j.avsg.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Among patients with peripheral artery disease (PAD), depression is diagnosed in 17-25% and negatively impacts wound healing, quality of life, and survival. We hypothesized that depression is underdiagnosed in patients with PAD. Additionally, given the associations between depression and mortality in PAD patients, there is an increased need to investigate the strength of this relationship. The present analysis includes 2 studies to address the following aims: (1) Investigation of the prevalence of concomitant PAD and depression in a cohort from the Southeastern United States, and (2) Examination of the association between depression and all-cause mortality in a cohort of Canadian patients with PAD. METHODS STUDY 1: From June-August 2022, the Patient Health Questionnaire Module 9 (PHQ-9) was administered to all patients seeking PAD-related care including medical, wound/podiatric, or vascular interventional/surgical treatment, in the University of North Carolina-Chapel Hill Vascular, Wound, and Podiatry clinics. The PHQ-9 assesses symptoms over 2 weeks and is scored 0-27, with higher scores indicating increasingly severe depression. Demographics, primary diagnosis, depression history, and antidepressant prescription were determined through chart review. We compared the proportion of positive depression screenings (PHQ-9 ≥ 5) to known depression. Among those treated for depression, the PHQ-9 score severity was evaluated. T-tests and χ2 tests were used to compare means and proportions. STUDY 2: From July 2015 to October 2016, the Geriatric Depression Scale Short Form was administered to adult patients with PAD undergoing revascularization. The Geriatric Depression Scale Short Form is a self-report measure of depression with a score >5 consistent with depression. The prevalence of depression was determined; primary outcome was all-cause mortality at 6 months. RESULTS STUDY 1: In 104 PAD patients (mean age 66.6 ± 11.3 years, 37% female), 37% of respondents scored ≥5 on the PHQ-9 survey, indicating at least mild depression. Only 18% of PAD patients had a history of depression, demonstrating a significant difference between the PHQ-9 findings and documented medical history. While depression was underdiagnosed in both men and women, men were more likely to have unrecognized depression (chi-squared statistic = 35.117, df = 1, P < 0.001). Among those with a history of depression, 74% had a current prescription for antidepressant medication, but 57% still had an elevated PHQ-9 score indicating possible undertreatment. STUDY 2: In 148 patients (mean age 70.3 ± 11.0 years, 39% female) the prevalence of screened depression was 28.4%, but only 3.3% had a documented history of depression suggesting significant underdiagnosis. Patients with depression were significantly more likely to die within 6 months of revascularization (9.5% vs. 0.9%; odds ratio 1.48, 95% confidence interval: 1.08 to 2.29). There was no association between depression and risk of length of stay, reintervention, or readmission. CONCLUSIONS Depression is underdiagnosed and undertreated among patients with PAD, which has grave consequences as it is associated with 1.5 times the odds of mortality within 6 months of revascularization. There is a critical need for more robust screenings and comprehensive mental health treatment for patients with concomitant depression and PAD.
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Affiliation(s)
- Katherine G Welch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Isabella Faria
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sydney E Browder
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospital de L'Université de Montréal, Montreal, Quebec, Canada
| | - Katharine L McGinigle
- Division of Vascular Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Scierka LE, Mena-Hurtado C, Ahmed ZV, Yousef S, Arham A, Grimshaw AA, Harris KM, Burg M, Vriens PW, Heyligers J, Lee M, Yazgan I, Smolderen KG. The association of depression with mortality and major adverse limb event outcomes in patients with peripheral artery disease: A systematic review and meta-analysis. J Affect Disord 2023; 320:169-177. [PMID: 36179780 DOI: 10.1016/j.jad.2022.09.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is highly prevalent and associated with poor outcomes. Depression is a risk factor for adverse outcomes in patients with coronary artery disease. Despite evidence showing that depression is common in patients with PAD, less is known about its association with adverse prognostic outcomes. To address this, we conducted a systematic review and meta-analysis to summarize the association between depression and outcomes in patients with PAD. METHODS We performed a systematic search of eight databases to January 2022 including studies that reported a risk estimate for the association of depression or depressive symptoms with all-cause mortality or major adverse limb events (MALE) in patients with PAD and pooled results in a meta-analysis. Risk of bias was assessed using ROBINS-I. RESULTS Of the 7048 articles screened, 5 observational studies with 119,123 patients were included. A total of 16.2 % had depression or depressive symptoms. Depression was associated with a statistically significant increased risk of all-cause mortality (HR 1.24, confidence interval 1.07-1.25, p = .005). The association between depression and MALE was not significant but trended toward a positive association. LIMITATIONS Due to lack of data, results were limited by a single study with a large sample size, overrepresentation of men, and lack of information of depression severity or treatment status. CONCLUSION Depression or depressive symptoms are associated with a 24 % increased risk of all-cause mortality in patients with PAD. Future work should explore the mechanisms and directionality of this association and identify depression as an important comorbidity to address for patients with PAD. REGISTRATION PROSPERO CRD 42021223694.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zain V Ahmed
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sameh Yousef
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ahmad Arham
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Kristie M Harris
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Burg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Patrick W Vriens
- Department of Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands
| | - Jan Heyligers
- Department of Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands
| | - Megan Lee
- Yale School of Medicine, New Haven, CT, USA
| | | | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Rezvani F, Pelt M, Härter M, Dirmaier J. Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis. PLoS One 2022; 17:e0273747. [PMID: 36048797 PMCID: PMC9436130 DOI: 10.1371/journal.pone.0273747] [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: 08/13/2021] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. Methods A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Results Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). Discussion The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Mara Pelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Demsas F, Joiner MM, Telma K, Flores AM, Teklu S, Ross EG. Disparities in peripheral artery disease care: A review and call for action. Semin Vasc Surg 2022; 35:141-154. [PMID: 35672104 PMCID: PMC9254894 DOI: 10.1053/j.semvascsurg.2022.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease that affects more than 6 million individuals 40 years and older in the United States, with sharp increases in prevalence with age. Morbidity and mortality rates in patients with PAD range from 30% to 70% during the 5- to 15-year period after diagnosis and PAD is associated with poor health outcomes and reduced functionality and quality of life. Despite advances in medical, endovascular, and open surgical techniques, there is striking variation in care among population subgroups defined by sex, race and ethnicity, and socioeconomic status, with concomitant differences in preoperative medication optimization, amputation risk, and overall health outcomes. We reviewed studies from 1995 to 2021 to provide a comprehensive analysis of the current impact of disparities on the treatment and management of PAD and offer action items that require strategic partnership with primary care providers, researchers, patients, and their communities. With new technologies and collaborative approaches, optimal management across all population subgroups is possible.
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Affiliation(s)
- Falen Demsas
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Kate Telma
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alyssa M Flores
- Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Elsie Gyang Ross
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Center for Biomedical Informatics Research, Stanford University, Stanford, CA; Stanford Cardiovascular Institute, 780 Welch Road, CJ350, Palo Alto, CA 94304.
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Kim S, Pendleton AA, McGinigle K. Peripheral Artery Disease: Diagnosis, Treatment, and Outcomes in Females. Semin Vasc Surg 2022; 35:155-161. [DOI: 10.1053/j.semvascsurg.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
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Pouncey AL, Woodward M. Sex-Specific Differences in Cardiovascular Risk, Risk Factors and Risk Management in the Peripheral Arterial Disease Population. Diagnostics (Basel) 2022; 12:diagnostics12040808. [PMID: 35453859 PMCID: PMC9027979 DOI: 10.3390/diagnostics12040808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in women worldwide but has been primarily recognised as a man’s disease. The major components of CVD are ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD). Compared with IHD or stroke, individuals with PAD are at significantly greater risk of major cardiovascular events. Despite this, they are less likely to receive preventative treatment than those with IHD. Women are at least as affected by PAD as men, but major sex-specific knowledge gaps exist in the understanding of relevant CVD risk factors and efficacy of treatment. This prompted the American Heart Association to issue a “call to action” for PAD in women, in 2012. Despite this, PAD and CVD risk in women continues to be under-recognised, leading to a loss of opportunity to moderate and prevent CVD morbidity. This review outlines current evidence regarding cardiovascular risk in women and men with PAD, the relative significance of traditional and non-traditional risk factors and sex differences in cardiovascular risk management.
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Affiliation(s)
- Anna Louise Pouncey
- Department of Vascular Surgery, Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, QEQM, St Mary’s Hospital, Praed Street, London W2 1NY, UK
- Correspondence:
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, London W12 0BZ, UK;
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia
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Pacheco C, Mullen KA, Coutinho T, Jaffer S, Parry M, Van Spall HG, Clavel MA, Edwards JD, Sedlak T, Norris CM, Dhukai A, Grewal J, Mulvagh SL. THE CANADIAN WOMEN’S HEART HEALTH ALLIANCE ATLAS ON THE EPIDEMIOLOGY, DIAGNOSIS, AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN WOMEN -- CHAPTER 5: SEX- AND GENDER-UNIQUE MANIFESTATIONS OF CARDIOVASCULAR DISEASE. CJC Open 2021; 4:243-262. [PMID: 35386135 PMCID: PMC8978072 DOI: 10.1016/j.cjco.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
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Ramirez JL, Zahner GJ, Arya S, Grenon SM, Gasper WJ, Sosa JA, Conte MS, Iannuzzi JC. Patients with depression are less likely to go home after critical limb revascularization. J Vasc Surg 2020; 74:178-186.e2. [PMID: 33383108 DOI: 10.1016/j.jvs.2020.12.079] [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: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although often overlooked during the preoperative evaluation, recent evidence has suggested that depression in patients with peripheral artery disease is associated with increased postoperative complications, including decreased primary and secondary patency after revascularization and an increased risk of major amputation and mortality. Postoperative nonhome discharge (NHD) is an important outcome for patients and has also been associated with other adverse outcomes; however, the effect that depression has on NHD after vascular surgery has remained unexplored. We hypothesized that depression would be associated with an increased risk of NHD after revascularization for chronic limb threatening ischemia (CLTI). METHODS Endovascular, open, and hybrid (combined open and endovascular) cases of revascularization for CLTI were identified from the 2012 to 2014 National (Nationwide) Inpatient Sample. CLTI, diagnoses of depression, and medical comorbidities were defined using the corresponding International Classification of Diseases, Ninth Revision, Clinical Modification codes. A hierarchical multivariable binary logistic regression controlling for hospital level variation and for confounders meeting P <.01 on bivariate analysis was used to examine the association between depression and NHD. A sensitivity analysis after coarsened exact matching for baseline characteristics that differed between the two groups was performed to reduce any imbalance. RESULTS A total of 64,817 cases were identified, of which 5472 (8.4%) included a diagnosis of depression and 16,524 (25.5%) NHD. The patients with depression were younger and more likely to be women and white, have multiple comorbidities and a nonelective admission, and experience a postoperative complication (P <.05). On unadjusted analyses, patients with depression had an 8% absolute increased risk of requiring NHD (32.1% vs 24.9%; P <.001). On multivariable analysis, patients with depression had an increased odds for NHD (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.40-1.61; c-statistic, 0.81) compared with those without depression. After stratification by operative approach, depression had a larger effect estimate in endovascular revascularization (OR, 1.57; 95% CI, 1.42-1.74) compared with open (OR, 1.45; 95% CI, 1.30-1.62). A test for interaction between depression and gender identified that men with depression had greater odds of NHD compared with women with depression (OR, 1.68; 95% CI, 1.51-1.88; vs OR, 1.37; 95% CI, 1.25-1.51; interaction P <.01). A sensitivity analysis after coarsened exact matching confirmed these findings. CONCLUSIONS To the best of our knowledge, the present study is the first to identify an association between depression and NHD after revascularization for CLTI. These results provide further evidence of the negative effects that comorbid depression has on patients undergoing revascularization for CLTI. Future studies should examine whether treating depression can improve the outcomes in this patient population.
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Affiliation(s)
- Joel L Ramirez
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Greg J Zahner
- Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Michael S Conte
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - James C Iannuzzi
- Department of Surgery, University of California, San Francisco, San Francisco, Calif.
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Jelani QUA, Mena-Hurtado C, Burg M, Soufer R, Gosch K, Jones PG, Spertus JA, Safdar B, Smolderen KG. Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences. J Am Heart Assoc 2020; 9:e014583. [PMID: 32781883 PMCID: PMC7660812 DOI: 10.1161/jaha.119.014583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The association of depressive symptoms with health status in peripheral artery disease (PAD) is understudied. No reports of differential impact on women have been described. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories) registry enrolled 1243 patients from vascular specialty clinics with new or worsening PAD symptoms. Depressive symptoms were assessed at baseline and 3 months using the 8‐Item Patient Health Questionnaire (score ≥10 indicating clinically relevant depressive symptoms). Disease‐specific and generic health status were measured by Peripheral Artery Questionnaire and EQ‐5D Visual Analogue Scale at baseline and 3, 6, and 12 months. An adjusted general linear model for repeated measures was constructed for baseline and 3‐, 6‐, and 12‐month health status outcomes by depressive symptoms at baseline. Differences by sex were tested with interaction effects. The mean age was 67.6±9.4 years with 38% (n=470) women. More women than men (21.1% versus 12.9%; P<0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all P<0.0001). Results were similar for EQ‐5D Visual Analogue Scale scores. The magnitude in 1‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in 1‐year Peripheral Artery Questionnaire summary scores. Conclusions Women with PAD have a high burden of depressive symptoms. Depressive symptoms were associated with a strikingly worse disease‐specific health status recovery path over the year following PAD diagnosis in men and women. Developing and testing interventions to address depressive symptoms in PAD are urgently needed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01419080.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Matthew Burg
- Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Robert Soufer
- Cardiovascular Medicine VA Connecticut Healthcare System West Haven CT
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - Basmah Safdar
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
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Wongkongkam K, Thosingha O, Ruangsetakit C, Phuntep K, Tonklai S. Psychological factors associated with functional recovery among patients with a peripheral arterial disease after lower extremity bypass. JOURNAL OF VASCULAR NURSING 2019; 37:3-10. [DOI: 10.1016/j.jvn.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
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Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes. Curr Atheroscler Rep 2018; 20:40. [PMID: 29858704 PMCID: PMC5984648 DOI: 10.1007/s11883-018-0742-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose of Review Peripheral arterial disease (PAD) is the third most common manifestation of cardiovascular disease (CVD), following coronary artery disease (CAD) and stroke. PAD remains underdiagnosed and under-treated in women. Recent Findings Women with PAD experience more atypical symptoms and poorer overall health status. The prevalence of PAD in women increases with age, such that more women than men have PAD after the age of 40 years. There is under-representation of PAD patients in clinical trials in general and women in particular. In this article, we address the lack of women participants in PAD trials. We then present a comprehensive overview of the epidemiology/risk factor profile, clinical features, treatment, and outcomes. Summary PAD is prevalent in women and its global burden is on the rise despite a decline in global age-standardized death rate from CVD. The importance of this issue has been underlined by the American Heart Association’s (AHA) “Call to Action” scientific statement on PAD in women. Large-scale campaigns are needed to increase awareness among physicians and the general public. Furthermore, effective treatment strategies must be implemented.
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Smolderen KG, Plomondon ME, Armstrong EJ, Hess E, Waldo S, Tsai TT, Maddox TM. Depression and long-term prognostic outcomes following peripheral endovascular interventions in the VA Healthcare System. Vasc Med 2018; 23:454-460. [PMID: 29801427 DOI: 10.1177/1358863x18770275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between depression and peripheral artery disease (PAD) outcomes remains widely understudied. In patients with PAD undergoing a peripheral vascular intervention (PVI) who have a recent diagnosis of depression, it is unknown what their long-term outcomes are and what factors may mediate an adverse risk. We therefore studied 797 consecutive patients undergoing PVI across 33 Veterans Affairs (VA) centers. Depression and outcomes were documented from patients' medical records. Outcomes included: (1) all-cause death; (2) non-fatal cardiovascular events (myocardial infarction, stroke); and (3) PAD-related events (including repeat PVI or amputation). Cox proportional hazards frailty models were constructed, adjusting for age. Additional covariates were selected if they resulted in at least 5% change in the age-adjusted hazard ratio (HR) for depression on outcomes. Overall, 265 (33%) patients had a diagnosis of depression. After a median follow-up of 955 days (range 1-6.25 years), 52 (6.5%) patients died, 30 (3.8%) experienced non-fatal cardiovascular events, and 176 (22.1%) had PAD-related events. Compared to patients without depression, depressed patients had higher rates of non-fatal cardiovascular events (6.4% vs 2.4%, p-value 0.0055). No differences for the other outcomes were noted. Higher risk for non-fatal cardiovascular events persisted after adjustment for age (HR 1.6, 95% CI 1.05-2.47). The only additional covariate that met our selection criteria was hypertension. After adjusting for hypertension, the association between depression and non-fatal cardiovascular outcomes attenuated (HR 1.53, 95% CI 0.99-2.35). In conclusion, a diagnosis of depression in veterans undergoing PVI was associated with increased risk of non-fatal cardiovascular events, mediated by age and hypertension.
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Affiliation(s)
- Kim G Smolderen
- 1 University of Missouri - Kansas City, Kansas City, MO, USA.,2 Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Mary E Plomondon
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Ehrin J Armstrong
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Edward Hess
- 3 University of Colorado - Denver, Denver, CO, USA
| | - Stephen Waldo
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | | | - Thomas M Maddox
- 6 Division of Cardiology, Washington University School of Medicine, St Louis, MO, USA
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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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Srivaratharajah K, Abramson BL. Women and Peripheral Arterial Disease: A Review of Sex Differences in Epidemiology, Clinical Manifestations, and Outcomes. Can J Cardiol 2018; 34:356-361. [DOI: 10.1016/j.cjca.2018.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
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Roumia M, Aronow HD, Soukas P, Gosch K, Smolderen KG, Spertus JA, Abbott JD. Sex differences in disease-specific health status measures in patients with symptomatic peripheral artery disease: Data from the PORTRAIT study. Vasc Med 2017; 22:103-109. [DOI: 10.1177/1358863x16686408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Mazen Roumia
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter Soukas
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kensey Gosch
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Kim G Smolderen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
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17
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Brostow DP, Petrik ML, Starosta AJ, Waldo SW. Depression in patients with peripheral arterial disease: A systematic review. Eur J Cardiovasc Nurs 2017; 16:181-193. [DOI: 10.1177/1474515116687222] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Megan L Petrik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, USA
- Department of Medicine, University of Minnesota Medical School, USA
| | - Amy J Starosta
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, USA
- Department of Psychiatry, University of Colorado, USA
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Wang GJ, Shaw PA, Townsend RR, Anderson AH, Xie D, Wang X, Nessel LC, Mohler ER, Sozio SM, Jaar BG, Chen J, Wright J, Taliercio JJ, Ojo A, Ricardo AC, Lustigova E, Fairman RM, Feldman HI, Ky B. Sex Differences in the Incidence of Peripheral Artery Disease in the Chronic Renal Insufficiency Cohort. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 9:S86-93. [PMID: 26908866 DOI: 10.1161/circoutcomes.115.002180] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To define how the incidence of peripheral artery disease (PAD) in chronic kidney disease differs according to sex and age. METHODS AND RESULTS The Chronic Renal Insufficiency Cohort (CRIC) is a multicenter, prospective cohort study of chronic kidney disease participants. Fine and Gray methods were used to determine the cumulative incidence of PAD, defined by an ankle brachial index <0.90 or a confirmed PAD event, with death as a competing event. Adjusted subdistribution hazard ratios from the Fine and Gray model determined the risk of PAD according to sex. A priori, we hypothesized that the relationship between sex and cumulative incidence of PAD differed according to age. The mean age of the 3174 participants in this study was 56.6 years and consisted of 55% males. During a median follow-up of 5.9 years, 17.8% developed PAD, 13.0% were lost to follow-up and 11.1% died. Females had a 1.53-fold greater adjusted PAD risk compared with males (95% confidence interval, 1.27-1.84; P<0.001). These sex-related differences in PAD risk also differed by age (P=0.013). Women, compared with men were at a markedly increased risk for PAD at younger ages; however, at ages >70 years, the risk was similar across both the sexes. Older men had a substantially greater PAD risk compared with younger men. In women, PAD risk did not vary with age. CONCLUSIONS Females with chronic kidney disease have a higher PAD risk compared with males at younger ages. There is an important need to improve our understanding of the biological and clinical basis for these differences.
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Affiliation(s)
- Grace J Wang
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
| | - Pamela A Shaw
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Raymond R Townsend
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Amanda H Anderson
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Dawei Xie
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Xue Wang
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Lisa C Nessel
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Emile R Mohler
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Stephen M Sozio
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Bernard G Jaar
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Jing Chen
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Jackson Wright
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Jonathan J Taliercio
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Akinlolu Ojo
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Ana C Ricardo
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Eva Lustigova
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Ronald M Fairman
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Harold I Feldman
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
| | - Bonnie Ky
- From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.)
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Dreyer RP, van Zitteren M, Beltrame JF, Fitridge R, Denollet J, Vriens PW, Spertus JA, Smolderen KG. Gender differences in health status and adverse outcomes among patients with peripheral arterial disease. J Am Heart Assoc 2014; 4:e000863. [PMID: 25537275 PMCID: PMC4330046 DOI: 10.1161/jaha.114.000863] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have examined gender differences in health status and cardiovascular outcomes in patients with peripheral artery disease (PAD). This study assessed (1) self-reported health status at PAD diagnosis and 12-months later, and explored (2) whether outcomes in women with PAD differ with regard to long-term major adverse events. METHODS AND RESULTS A total of 816 patients (285 women) with PAD were enrolled from 2 vascular clinics in the Netherlands. Baseline clinical data and subsequent adverse events were recorded and patients completed the Short Form-12 (SF-12, Physical Component Score [PCS] and Mental Component Score [MCS]) upon PAD diagnosis and 12-months later. Women had similar ages and clinical characteristics, but poorer socio-economic status and more depressive symptoms at initial diagnosis, as compared with men. Women also had poorer physical (PCS: 37±10 versus 40±10, P=0.004) and mental ( MCS 47±12 versus 49±11, P=0.005) health status at the time of presentation. At 12-months, women still reported a poorer overall PCS score (41±12 versus 46±11, P=0.006) and MCS score (42±14 versus 49±12, P=0.002). Female gender was an independent determinant of a poorer baseline and 12-month PCS and MCS scores. However, there were no significant differences by gender on either mortality (unadjusted hazard ratio [HR]=0.93, 95% CI 0.60;1.44, P=0.74) or major adverse events (unadjusted HR=0.90, 95% CI 0.63;1.29, P=0.57), after a median follow-up of 3.2 years. CONCLUSIONS Women's physical and mental health status is compromised both at initial PAD diagnosis and at 12-month follow-up, despite experiencing a similar magnitude of change in their health scores throughout the first 12-months after diagnosis.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), New Haven, CT (R.P.D.) Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.P.D.)
| | - Moniek van Zitteren
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (M.Z., J.D.) Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (M.Z., P.W.V.)
| | - John F Beltrame
- Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia (J.F.B.)
| | - Robert Fitridge
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia (R.F.)
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (M.Z., J.D.)
| | - Patrick W Vriens
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (M.Z., P.W.V.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.G.S.) UMKC-University of Missouri-Kansas City, Kansas City, MO (J.A.S., K.G.S.)
| | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.G.S.) UMKC-University of Missouri-Kansas City, Kansas City, MO (J.A.S., K.G.S.)
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21
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Grenon SM, Cohen BE, Smolderen K, Vittinghoff E, Whooley MA, Hiramoto J. Peripheral arterial disease, gender, and depression in the Heart and Soul Study. J Vasc Surg 2014; 60:396-403. [PMID: 24661811 DOI: 10.1016/j.jvs.2014.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the high prevalence of peripheral arterial disease (PAD) in women, risk factors for PAD in women are not well understood. METHODS Gender-specific risk factors for PAD were examined in a prospective cohort study of 1024 patients (184 women and 840 men) with stable coronary artery disease who were recruited between 2000 and 2002. Logistic regression models were used to evaluate associations between traditional and nontraditional risk factors and PAD in men and women. RESULTS PAD was found in 11% of women and in 13% of men. Women with PAD had a similar prevalence of traditional risk factors (hypertension, hyperlipidemia, and smoking) compared with women without PAD and were significantly more likely to suffer from depression than women without PAD. Men with PAD were more likely to have hypertension, diabetes mellitus, a history of smoking, a worse lipid profile, and higher levels of inflammatory biomarkers than men without PAD. A multivariate model showed depression was the strongest independent factor associated with PAD in women, whereas smoking and elevated fibrinogen were independently associated with PAD in men. CONCLUSIONS The current findings suggest there are gender differences in risk factors for the development of PAD. Further research is needed to understand the role of depression in PAD.
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Affiliation(s)
- S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif.
| | - Beth E Cohen
- Department of Medicine, University of California, San Francisco, San Francisco, Calif; Department of Medicine, Veterans Affairs Medical Center, San Francisco, Calif
| | - Kim Smolderen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; St. Luke's Mid America Heart Institute, Kansas City, Mo
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, San Francisco, Calif; Department of Medicine, Veterans Affairs Medical Center, San Francisco, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif
| | - Jade Hiramoto
- Department of Surgery, University of California, San Francisco, San Francisco, Calif
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22
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Renoir T, Hasebe K, Gray L. Mind and body: how the health of the body impacts on neuropsychiatry. Front Pharmacol 2013; 4:158. [PMID: 24385966 PMCID: PMC3866391 DOI: 10.3389/fphar.2013.00158] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/30/2013] [Indexed: 12/24/2022] Open
Abstract
It has long been established in traditional forms of medicine and in anecdotal knowledge that the health of the body and the mind are inextricably linked. Strong and continually developing evidence now suggests a link between disorders which involve Hypothalamic-Pituitary-Adrenal axis (HPA) dysregulation and the risk of developing psychiatric disease. For instance, adverse or excessive responses to stressful experiences are built into the diagnostic criteria for several psychiatric disorders, including depression and anxiety disorders. Interestingly, peripheral disorders such as metabolic disorders and cardiovascular diseases are also associated with HPA changes. Furthermore, many other systemic disorders associated with a higher incidence of psychiatric disease involve a significant inflammatory component. In fact, inflammatory and endocrine pathways seem to interact in both the periphery and the central nervous system (CNS) to potentiate states of psychiatric dysfunction. This review synthesizes clinical and animal data looking at interactions between peripheral and central factors, developing an understanding at the molecular and cellular level of how processes in the entire body can impact on mental state and psychiatric health.
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Affiliation(s)
- Thibault Renoir
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, University of MelbourneMelbourne, VIC, Australia
| | - Kyoko Hasebe
- School of Medicine, Deakin UniversityGeelong, VIC, Australia
| | - Laura Gray
- School of Medicine, Deakin UniversityGeelong, VIC, Australia
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23
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Donnelly TT, Al Suwaidi JM, Alqahtani A, Assad N, Qader NA, Byrne C, Singh R, Fung TS. Study exploring depression and cardiovascular diseases amongst Arabic speaking patients living in the State of Qatar: Rationale and methodology. Glob Cardiol Sci Pract 2013; 2012:56-66. [PMID: 24688991 PMCID: PMC3963714 DOI: 10.5339/gcsp.2012.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 12/02/2012] [Indexed: 11/24/2022] Open
Abstract
In Qatar, cardiovascular diseases are the leading cause of death. Studies show that depression is associated with an increased morbidity and mortality among cardiovascular patients. Thus, early detection of, and intervention for, depression among cardiovascular patients can reduce cardiovascular morbidity and mortality, and save health care costs. To date there is no study in the Gulf region exploring depression among cardiovascular patients. The goals of our three-phase research program are to (1) understand the mental health issues, specifically depression, as experienced by cardiovascular patients living in the State of Qatar; (2) identify and implement strategies that would prevent depression and assist patients to deal with depression; and (3) evaluate, facilitate, and sustain strategies that are effective at reducing depression and foster its treatment among cardiovascular patients. This paper describe phase I of the research program. Using both quantitative and qualitative research methodologies, we will investigate (1) the prevalence and severity of depression among patients who have confirmed diagnosis of cardiovascular diseases (2) how contextual factors such as social, cultural, and economic factors contribute to the risk of depression and its management among cardiovascular patients, and (3) formulate effective intervention strategies that are expected to increase awareness, prevention of and treatment for depression among cardiovascular patients, thus reducing cardiovascular diseases morbidity and mortality in Qatar.
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24
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Peripheral Arterial Disease Is an Overlooked Women's Issue. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e31828aa41a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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