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Rodin R, Smith AK, Espejo E, Gan S, Boscardin WJ, Hunt LJ, Ornstein KA, Morrison RS. Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure. JAMA Netw Open 2024; 7:e2432979. [PMID: 39264625 PMCID: PMC11393717 DOI: 10.1001/jamanetworkopen.2024.32979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Importance The widowhood effect, in which mortality increases and function decreases in the period following spousal death, may be heightened in older adults with functional impairment and serious illnesses, such as cancer, dementia, or organ failure, who are highly reliant on others, particularly spouses, for support. Yet there are limited data on widowhood among people with these conditions. Objective To determine the association of widowhood with function and mortality among older adults with dementia, cancer, or organ failure. Design, Setting, and Participants This longitudinal cohort study used population-based, nationally representative data from the Health and Retirement Study database linked to Medicare claims from 2008 to 2018. Participants were married or partnered community-dwelling adults aged 65 years and older with and without cancer, organ failure, or dementia and functional impairment (function score <9 of 11 points), matched on widowhood event and with follow-up until death or disenrollment. Analyses were conducted from September 2021 to May 2024. Exposure Widowhood. Main Outcomes and Measures Function score (range 0-11 points; 1 point for independence with each activity of daily living [ADL] or instrumental activity of daily living [IADL]; higher score indicates better function) and 1-year mortality. Results Among 13 824 participants (mean [SD] age, 70.1 [5.5] years; 6416 [46.4%] female; mean [SD] baseline function score, 10.2 [1.6] points; 1-year mortality: 0.4%) included, 5732 experienced widowhood. There were 319 matched pairs of people with dementia, 1738 matched pairs without dementia, 95 matched pairs with cancer, 2637 matched pairs without cancer, 85 matched pairs with organ failure, and 2705 matched pairs without organ failure. Compared with participants without these illnesses, widowhood was associated with a decline in function immediately following widowhood for people with cancer (change, -1.17 [95% CI, -2.10 to -0.23] points) or dementia (change, -1.00 [95% CI, -1.52 to -0.48] points) but not organ failure (change, -0.84 [95% CI, -1.69 to 0.00] points). Widowhood was also associated with increased 1-year mortality among people with cancer (hazard ratio [HR], 1.08 [95% CI, 1.04 to 1.13]) or dementia (HR, 1.14 [95% CI, 1.02 to 1.27]) but not organ failure (HR, 1.02 [95% CI, 0.98 to 1.06]). Conclusions and Relevance This cohort study found that widowhood was associated with increased functional decline and increased mortality in older adults with functional impairment and dementia or cancer. These findings suggest that persons with these conditions with high caregiver burden may experience a greater widowhood effect.
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Affiliation(s)
- Rebecca Rodin
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Edie Espejo
- Northern California Institute for Research and Education, San Francisco
| | - Siqi Gan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - W John Boscardin
- Northern California Institute for Research and Education, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lauren J Hunt
- Department of Physiological Nursing, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco
| | | | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York
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Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21:603-616. [PMID: 38698183 DOI: 10.1038/s41569-024-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Diagnostic Imaging, Emory University School of Medicine, Atlanta, GA, USA
- Veterans Administration Medical Center, Decatur, GA, USA
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Huang C, Peng J, Lee PMY, Wang C, Wei K, Liang M, Qin G, Yu Y, Li J. Sibling Death in Childhood and Early Adulthood and Risk of Early-Onset Cardiovascular Disease. JAMA Netw Open 2024; 7:e2350814. [PMID: 38190182 PMCID: PMC10774991 DOI: 10.1001/jamanetworkopen.2023.50814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Importance Sibling death is a highly traumatic event, but empirical evidence on the association of sibling death in childhood and early adulthood with subsequent risk of incident cardiovascular disease (CVD) remains limited. Objective To evaluate the association between sibling death in the early decades of life and subsequent risk of incident early-onset CVD. Design, Setting, and Participants This population-based cohort study included 2 098 659 individuals born in Denmark from 1978 to 2018. Follow-up started at age 1 year or the date of the first sibling's birth, whichever occurred later, and it ended at the first diagnosis of CVD, the date of death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 1, 2021, through January 10, 2022. Exposures The death of a sibling. Main Outcomes and Measures The outcome was early-onset CVD. Cox models were used to estimate hazard ratios (HRs) with 95% CIs. Results This study included 2 098 659 individuals (1 076 669 [51.30%] male; median [IQR] age at death of sibling, 11.48 [4.68-21.32] years). During the median (IQR) follow-up of 17.52 (8.85-26.05) years, 1286 and 76 862 individuals in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD. Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR, 1.17; 95% CI, 1.10-1.23; cumulative incidence in bereaved individuals, 1.96% [1.61%-2.34%]; cumulative incidence in nonbereaved individuals at age 41 years, 1.35% [1.34%-1.37%]; cumulative incidence difference: 0.61% [95% CI, 0.24%-0.98%]). Increased risks were also observed for most type-specific CVDs, in particular for myocardial infarction (HR, 1.66; 95% CI, 1.12-2.46), ischemic heart disease (HR, 1.52; 95% CI, 1.22-1.90), and heart failure (HR, 1.50; 95% CI, 1.00-2.26). The association was observed whether the sibling died due to CVD (HR, 2.54; 95% CI, 2.04-3.17) or non-CVD (HR, 1.13; 95% CI, 1.06-1.19) causes. The increased risk of CVD was more pronounced for individuals who lost a twin or younger sibling (HR, 1.25; 95% CI, 1.15-1.36) than an elder sibling (HR, 1.11; 95% CI, 1.03-1.20). Conclusions and Relevance In this cohort study of the Danish population, sibling death in childhood and early adulthood was associated with increased risks of overall and most type-specific early-onset CVDs, with the strength of associations varying by cause of death and age difference between sibling pairs. The findings highlight the need for extra attention and support to the bereaved siblings to reduce CVD risk later in life.
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Affiliation(s)
- Chen Huang
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Jiahuan Peng
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Priscilla Ming Yi Lee
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ce Wang
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Kecheng Wei
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Minhong Liang
- Shanghai Hongkou Center for Disease Control and Prevention, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Jiong Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
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Wei D, Janszky I, Ljung R, Fang F, Li J, László KD. Bereavement and Prognosis After a First Acute Myocardial Infarction: A Swedish Register-Based Cohort Study. J Am Heart Assoc 2022; 11:e027143. [PMID: 36056733 PMCID: PMC9496408 DOI: 10.1161/jaha.122.027143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 Despite accumulating evidence suggesting that bereavement is associated with increased risks of cardiovascular morbidity and mortality, the association between bereavement and prognosis after acute myocardial infarction (AMI) has not been well documented. We investigated the association by using Swedish register data. METHODS AND RESULTS We studied 266 651 patients with a first AMI included in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) quality register from 1991 to 2018. We obtained information on bereavement (ie, death of a partner, child, grandchild, sibling, or parent), on primary (nonfatal recurrent AMI and death attributed to ischemic heart disease) and secondary outcomes (total mortality, heart failure, and stroke) and on covariates from several national registers. The association was analyzed using Poisson regression. The bereaved patients had a slightly increased risk of the primary outcome; the corresponding risk ratio (RR) was 1.02 (95% CI, 1.00-1.04). An increased risk was noted any time bereavement occurred, except if the loss was in the year after the first AMI. The association was strongest for the loss of a partner, followed by the loss of a child, grandchild, sibling, or parent. We also observed increased risks for total mortality (RR, 1.14 [95% CI, 1.12-1.16]), heart failure (RR, 1.05 [95% CI, 1.02-1.08]), and stroke (RR, 1.09 [95% CI, 1.05-1.13]) following bereavement. CONCLUSIONS Bereavement was associated with an increased risk of poor prognosis after a first AMI. The association varied by the relationship to the deceased.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health Karolinska Institutet Stockholm Sweden.,Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Imre Janszky
- Department of Global Public Health Karolinska Institutet Stockholm Sweden.,Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden.,Swedish Medical Products Agency Uppsala Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology Aarhus University Aarhus Denmark
| | - Krisztina D László
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
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Brezulianu A, Burlacu A, Popa IV, Arif M, Geman O. “Not by Our Feeling, But by Other's Seeing”: Sentiment Analysis Technique in Cardiology—An Exploratory Review. Front Public Health 2022; 10:880207. [PMID: 35480589 PMCID: PMC9035821 DOI: 10.3389/fpubh.2022.880207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Sentiment Analysis (SA) is a novel branch of Natural Language Processing (NLP) that measures emotions or attitudes behind a written text. First applications of SA in healthcare were the detection of disease-related emotional polarities in social media. Now it is possible to extract more complex attitudes (rank attitudes from 1 to 5, assign appraisal values, apply multiple text classifiers) or feelings through NLP techniques, with clear benefits in cardiology; as emotions were proved to be veritable risk factors for the development of cardiovascular diseases (CVD). Our narrative review aimed to summarize the current directions of SA in cardiology and raise the awareness of cardiologists about the potentiality of this novel domain. This paper introduces the readers to basic concepts surrounding medical SA and the need for SA in cardiovascular healthcare. Our synthesis of the current literature proved SA's clinical potential in CVD. However, many other clinical utilities, such as the assessment of emotional consequences of illness, patient-physician relationship, physician intuitions in CVD are not yet explored. These issues constitute future research directions, along with proposing detailed regulations, popularizing health social media among elders, developing insightful definitions of emotional polarity, and investing research into the development of powerful SA algorithms.
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Affiliation(s)
- Adrian Brezulianu
- Faculty of Electronics, Telecommunications and Information Technology, “Gheorghe Asachi” Tehnical University, Iaşi, Romania
- GreenSoft Ltd., Iaşi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
- Department of Interventional Cardiology - Cardiovascular Diseases Institute, Iaşi, Romania
| | - Iolanda Valentina Popa
- GreenSoft Ltd., Iaşi, Romania
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
- *Correspondence: Iolanda Valentina Popa
| | - Muhammad Arif
- Department of Computer Science and Information Technology, University of Lahore, Lahore, Pakistan
- Muhammad Arif
| | - Oana Geman
- Neuroaesthetics Laboratory, “Ştefan cel Mare” University, Suceava, Romania
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6
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Ang CS. Life Will Never be the Same: Experiences of Grief and Loss among Older Adults. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Theorell T. Psychosocial stressors in psychosomatic cardiology: A narrative review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Saltzman LY. Sex Differences in the Relationship Between Child Maltreatment, Recent Bereavement, and Average Heart Rate. OMEGA-JOURNAL OF DEATH AND DYING 2021; 84:459-473. [PMID: 31865859 PMCID: PMC7306425 DOI: 10.1177/0030222819894139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study explores the sex differences in cardiovascular outcomes among bereaved individuals. In addition, the study differentiates the impact of child maltreatment and recent loss on the physical health of adult men and women. This study conducted a secondary analysis of data drawn from the Biomarker Subproject of the National Survey of Midlife Development in the United States (n = 1,255). Analysis included a series of regression models estimated in Stata version 15.1. A main effect for both sex and loss was observed. Both male and female respondents with loss had higher average heart rates as compared to male respondents without loss. Interestingly, being a female without loss was also associated with a higher average heart rate as compared to males without loss. The findings suggest that sex differences in cardiovascular functioning do occur and that these differences may be exacerbated by experiences of trauma and loss, and this relationship has implications for assessment and intervention.
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Affiliation(s)
- Leia Y Saltzman
- School of Social Work, Tulane University, New Orleans, LA, USA
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9
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Welzel FD, Löbner M, Quittschalle J, Pabst A, Luppa M, Stein J, Riedel-Heller SG. Loss and bereavement in late life (60+): Study protocol for a randomized controlled trial regarding an internet-based self-help intervention. Internet Interv 2021; 26:100451. [PMID: 34540595 PMCID: PMC8437767 DOI: 10.1016/j.invent.2021.100451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The death of a close person is a highly stressful, yet common life event in later life. While most individuals seem to cope well with bereavement, a substantial proportion of older individuals suffer from prolonged grief symptoms. E-mental health interventions have been shown to be efficient for a variety of psychological illnesses. Yet, there is a large research gap of studies with a special focus on older adults. This study protocol describes a randomized controlled trial for an internet-based self-help intervention addressing bereavement and loss in adults aged 60 years and over. The self-management intervention is based on techniques of cognitive behavioral therapy and consists of 8 modules. The objective of the AgE-health study is to evaluate the effectiveness and acceptability of this intervention in comparison to a bibliotherapy control group. METHODS The AgE-health study aims at implementing a randomized controlled trial. Eligible participants aged 60+ years will be randomly allocated to an intervention group (access to the intervention) or to an active control group (access to bibliotherapy). Primary outcome is the reduction in grief symptoms (13-item Prolonged Grief Inventory); secondary outcomes are depression, social activity and network, quality of life, self-efficacy, satisfaction with the intervention/bibliotherapy, loneliness, acceptability, up-take and adherence. Assessments will take place before the intervention (baseline) as well as 4 months (follow-up 1) after the intervention. DISCUSSION This study addresses an under-recognized and understudied mental health burden in later life and may add valuable insight into our knowledge about the effectiveness of eHealth interventions for loss and bereavement in late life. To our knowledge, the AgE-health study will be the first randomized controlled trial to evaluate the effectiveness of an internet-based intervention targeting prolonged grief in adults aged 60 years and over. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register (Identifier: DRKS00020595, Registered 30th July 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020595).
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Affiliation(s)
- Franziska D. Welzel
- Corresponding author at: Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | | | - Janine Quittschalle
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
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Olsson A, Thorén I, Mohammad MA, Rylance R, Platonov PG, Sparv D, Erlinge D. Christmas holiday triggers of myocardial infarction. SCAND CARDIOVASC J 2021; 55:340-344. [PMID: 34585998 DOI: 10.1080/14017431.2021.1983638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas. Design: A nationwide, retrospective postal survey with case-control design. All individuals suffering an MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual. Results: A total of 189 patients suffering an MI on Christmas Eve, Christmas Day, or Boxing Day, and 157 patients in the control group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (37% vs. 21%, p = .002), depression (21% vs. 11%, p = .024), and worry (26% vs. 10%, p < .001) compared to the control group. The food and sweets consumption was increased in both groups, but to a greater extent in the control group (33% vs. 50%, p = .002 and 32% vs. 43%, p = .031). There were no increases in quarrels, anger, economic worries, or reduced compliance with medication. Conclusions: Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly contributing to the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.
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Affiliation(s)
- Anneli Olsson
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Ida Thorén
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Sparv
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
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11
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Bidulka P, Vestergaard SV, Hlupeni A, Kjærsgaard A, Wong AYS, Langan SM, Schmidt SAJ, Lyon S, Christiansen CF, Nitsch D. Adverse outcomes after partner bereavement in people with reduced kidney function: Parallel cohort studies in England and Denmark. PLoS One 2021; 16:e0257255. [PMID: 34555018 PMCID: PMC8460004 DOI: 10.1371/journal.pone.0257255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate whether partner bereavement is associated with adverse cardiovascular and kidney-related events in people with reduced kidney function. DESIGN Two parallel matched cohort studies using linked routinely collected health data. SETTING England (general practices and hospitals using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics) and Denmark (hospitals and community pharmacies using the Danish National Patient, Prescription and Education Registries and the Civil Registration System). PARTICIPANTS Bereaved people with reduced kidney function (estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (England) or hospital-coded chronic kidney disease (Denmark)) and non-bereaved people with reduced kidney function similarly defined, matched on age, sex, general practice (England), and county of residence (Denmark) and followed-up from the bereavement date of the exposed person. MAIN OUTCOME MEASURES Cardiovascular disease (CVD) or acute kidney injury (AKI) hospitalization, or death. RESULTS In people with reduced kidney function, we identified 19,820 (England) and 5,408 (Denmark) bereaved individuals and matched them with 134,828 (England) and 35,741 (Denmark) non-bereaved individuals. Among the bereaved, the rates of hospitalizations (per 1000 person-years) with CVD were 31.7 (95%-CI: 30.5-32.9) in England and 78.8 (95%-CI: 74.9-82.9) in Denmark; the rates of hospitalizations with AKI were 13.2 (95%-CI: 12.5-14.0) in England and 11.2 (95%-CI: 9.9-12.7) in Denmark; and the rates of death were 70.2 (95%-CI: 68.5-72.0) in England and 126.4 (95%-CI: 121.8-131.1) in Denmark. After adjusting for confounders, we found increased rates of CVD (England, HR 1.06 [95%-CI: 1.01-1.12]; Denmark, HR 1.10 [95%-CI: 1.04-1.17]), of AKI (England, HR 1.20 [95%-CI: 1.10-1.31]; Denmark HR 1.36 [95%-CI: 1.17-1.58]), and of death (England, HR 1.10 [95%-CI: 1.05-1.14]; Denmark HR 1.20 [95%-CI: 1.15-1.25]) in bereaved compared with non-bereaved people. CONCLUSIONS Partner bereavement is associated with an increased rate of CVD and AKI hospitalization, and death in people with reduced kidney function. Additional supportive care for this at-risk population may help prevent serious adverse events.
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Affiliation(s)
- Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Admire Hlupeni
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Angel Y. S. Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sinéad M. Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sigrun Alba Johannesdottir Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Lyon
- Kidney Transplant Recipient, and Widow of Kidney Transplant Recipient, London, United Kingdom
| | | | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Wei D, Janszky I, Fang F, Chen H, Ljung R, Sun J, Li J, László KD. Death of an offspring and parental risk of ischemic heart diseases: A population-based cohort study. PLoS Med 2021; 18:e1003790. [PMID: 34587153 PMCID: PMC8480908 DOI: 10.1371/journal.pmed.1003790] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The death of a child is an extreme life event with potentially long-term health consequences. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), however, is very limited. We investigated whether the death of an offspring is associated with the risk of IHD and AMI. METHODS AND FINDINGS We studied parents of live-born children recorded in the Danish (1973 to 2016) and the Swedish (1973 to 2014) Medical Birth Registers (n = 6,711,952; mean age at baseline 31 years, 53% women). We retrieved information on exposure, outcomes, and covariates by linking individual-level information from several nationwide registers. We analyzed the abovementioned associations using Poisson regression. A total of 126,522 (1.9%) parents lost at least 1 child during the study period. Bereaved parents had a higher risk of IHD and AMI than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]. The association was present not only in case of losses due to CVD or other natural causes, but also in case of unnatural deaths. The AMI risk was highest in the first week after the loss [IRR (95% CI): 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period. Study limitations include the possibility of residual confounding by socioeconomic, lifestyle, or health-related factors and the potentially limited generalizability of our findings outside Scandinavia. CONCLUSIONS The death of an offspring was associated with an increased risk of IHD and AMI. The finding that the association was present also in case of losses due to unnatural causes, which are less likely to be confounded by cardiovascular risk factors clustering in families, suggests that stress-related mechanisms may also contribute to the observed associations.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Swedish Medical Products Agency, Uppsala, Sweden
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D. László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Clemens V, Bürgin D, Huber-Lang M, Plener PL, Brähler E, Fegert JM. The Interplay between Child Maltreatment and Stressful Life Events during Adulthood and Cardiovascular Problems-A Representative Study. J Clin Med 2021; 10:jcm10173937. [PMID: 34501385 PMCID: PMC8432252 DOI: 10.3390/jcm10173937] [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: 06/29/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 01/01/2023] Open
Abstract
Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1; 1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1; 2.3]) and myocardial infarction (ORwomen = 2.1 [1.0; 4.3], ORmen = 1.8 [1.1; 2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health.
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Affiliation(s)
- Vera Clemens
- Department for Child and Adolescent Psychiatry/Psychotherapy, Steinhövelstraße 5, University of Ulm, 89075 Ulm, Germany; (P.L.P.); (J.M.F.)
- Correspondence: ; Tel.: +49-731-500-61611
| | - David Bürgin
- Department of Child and Adolescent Psychiatry, Psychiatric Hospitals of the University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland;
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Medical Centre, Helmholtzstraße 8/1, 89081 Ulm, Germany;
| | - Paul L. Plener
- Department for Child and Adolescent Psychiatry/Psychotherapy, Steinhövelstraße 5, University of Ulm, 89075 Ulm, Germany; (P.L.P.); (J.M.F.)
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Elmar Brähler
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany;
- Integrated Research and Treatment Center (IFB) Adiposity Diseases-Behavioral Medicine, Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany
| | - Jörg M. Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, Steinhövelstraße 5, University of Ulm, 89075 Ulm, Germany; (P.L.P.); (J.M.F.)
- Head of the Competence Area Mental Health Prevention Network Baden-Württemberg, Steinhövelstraße 5, 89075 Ulm, Germany
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14
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Ohbe H, Yasunaga H. Spouse's Cardiovascular Disease As a Risk Factor for Cardiovascular Disease in Middle-Aged Adults: A Matched-Pair Cohort Study. Circ Cardiovasc Qual Outcomes 2021; 14:e007649. [PMID: 34238013 DOI: 10.1161/circoutcomes.120.007649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the risk of subsequent cardiovascular events in individuals whose spouse has a history of cardiovascular diseases. We assessed whether the spouse's history of cardiovascular disease is associated with a greater risk of cardiovascular events. METHODS Using data on married couples from the Japan Medical Data Center database (April 2008-August 2018), we conducted a matched-pair cohort study by matching individuals who had no history of cardiovascular disease and whose spouse had a history of cardiovascular disease at their first health check-up (exposure group) with up to 4 individuals who had no history of cardiovascular disease and whose spouse had no history of cardiovascular disease at their first health check-up (nonexposure group) matched for birth year, sex, and first health check-up year. We compared severe cardiovascular events after the first health check-up between the 2 groups. RESULTS Among 236 527 eligible married couples (473 054 spouses), we identified 13 759 individuals in the exposure group who were matched with 55 027 individuals in the nonexposure group. During the mean 95-month observational period from the first health check-up, the percentage of individuals with severe cardiovascular events was higher in the exposure group than in the nonexposure group (0.6% [82/13 759] versus 0.4% [224/55 027], respectively), with a hazard ratio of 1.48 (95% CI, 1.15-1.90). Analyses stratified by sex showed that the hazard ratios of the exposure to the spouse's history of cardiovascular disease for severe cardiovascular events in women and men were 1.22 (95% CI, 0.82-1.83) and 1.68 (95% CI, 1.22-2.32), respectively. CONCLUSIONS This study suggests that a spouse's history of cardiovascular disease can be a risk factor for subsequent cardiovascular events in men but not in women. Further studies are needed to confirm our findings and to explore effective primary prevention strategies for these individuals.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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15
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Wilson DM, Underwood L, Errasti-Ibarrondo B. A scoping research literature review to map the evidence on grief triggers. Soc Sci Med 2021; 282:114109. [PMID: 34157614 DOI: 10.1016/j.socscimed.2021.114109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
Grief is understandably severe in the first days, if not weeks or months, following the death of a beloved person. Unless the mourner develops complicated grief, which is prolonged severe and impactful grief, the initial acute grief lessens in severity over time, although waves of significant grief will still occur with grief triggers. A scoping research literature review was undertaken in early 2021 to determine how often grief triggers occur, what the most common grief triggers are, the impact of triggered grief, and what can be done (by those not diagnosed with complicated grief) to manage grief triggers and mitigate the effect of them. Nine academic library databases were searched for English-language research reports using the keywords "grief trigger(s)" and "research": CINAHL, Directory of Open Access (online) Journals, Humanities Index, JSTOR, Medline (Ovid), Periodicals Index Online, PsychArticles, Scopus, and Web of Science. Six research papers relevant for review were published in the last two decades, with some evidence gained on how often grief triggers occur, what constitutes a grief trigger, and the impact of grief triggers. Major gaps in evidence were revealed, despite grief triggers being identified as a major consideration for grief in general and for grief recovery specifically.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G1C9, Canada.
| | - Leah Underwood
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G1C9, Canada
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16
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Zhang S, Zhang Y, Wang X, Wu L, Shen J, Gu M, Fang Z. Effects of Shenfu Qiangxin Drink on H 2O 2-induced oxidative stress, inflammation and apoptosis in neonatal rat cardiomyocytes and possible underlying mechanisms. Exp Ther Med 2021; 21:553. [PMID: 33850525 PMCID: PMC8027745 DOI: 10.3892/etm.2021.9985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the effects of Shenfu Qiangxin Drink (SFQXD) on acute myocardial infarction (AMI) and identify the possible underlying mechanisms. Levels of reactive oxygen species (ROS) and inflammatory factors, including interleukin (IL)-6, IL-1β and tumor necrosis factor-α (TNF-α) in the blood samples of patients with AMI were measured using commercially available kits by visible spectrophotometry after SFQXD administration. The contents of phosphorylated (p-) forkhead box O3a (FOXO3a) was examined using an ELISA kit. In addition, a hydrogen peroxide (H2O2)-induced myocardial injury model was established in vitro using neonatal rat cardiomyocytes. Following treatment with SFQXD, the levels of intracellular ROS, cell apoptosis, oxidative stress- and inflammation-related markers were measured using commercially available kits by visible spectrophotometry. Additionally, western blot analysis was used to measure the expression of sirtuin-4 (SIRT4), p-FOXO3a, acetylated FOXO3a (ace-FOXO3a) and apoptosis-related genes (Bcl-2, Bax, BIM and cleaved caspase-3). Subsequently, to investigate the possible underlying regulatory mechanisms, SIRT4 expression was silenced by transfection with small hairpin RNA against SIRT4, following which changes in the extent of oxidative stress, inflammation and apoptosis were assessed. The levels of ROS and interleukin (IL)-1β were found to be significantly reduced, whilst FOXO3a phosphorylation was markedly increased following administration with SFQXD. In vitro, SFQXD dose-dependently inhibited H2O2-induced oxidative stress, inflammation and apoptosis in neonatal rat cardiomyocytes. In addition, FOXO3a phosphorylation was markedly upregulated whilst FOXO3a acetylation was downregulated following treatment of H2O2-induced primary neonatal cardiomyocytes with SFQXD. SIRT4 knockdown also markedly reversed the effects of SFQXD on oxidative stress, inflammation and apoptosis in neonatal rat cardiomyocytes. In conclusion, these findings demonstrated that SFQXD may alleviate oxidative stress-induced myocardial injury by potentially regulating SIRT4/FOXO3a signaling, suggesting that SFQXD may be of clinical value for the treatment of AMI.
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Affiliation(s)
- Sujie Zhang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Yiyan Zhang
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Xindong Wang
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Lixing Wu
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Jianping Shen
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Minglin Gu
- Department of Cardiology, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu 210028, P.R. China
| | - Zhuyuan Fang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
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17
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Affiliation(s)
- Kim G Smolderen
- Yale University, School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Matthew M Burg
- Yale University, School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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18
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Rosman L, Salmoirago-Blotcher E, Mahmood R, Yang H, Li Q, Mazzella AJ, Lawrence Klein J, Bumgarner J, Gehi A. Arrhythmia Risk During the 2016 US Presidential Election: The Cost of Stressful Politics. J Am Heart Assoc 2021; 10:e020559. [PMID: 34014121 PMCID: PMC8483504 DOI: 10.1161/jaha.120.020559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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 Anger and extreme stress can trigger potentially fatal cardiovascular events in susceptible people. Political elections, such as the 2016 US presidential election, are significant stressors. Whether they can trigger cardiac arrhythmias is unknown. Methods and Results In this retrospective case‐crossover study, we linked cardiac device data, electronic health records, and historic voter registration records from 2436 patients with implanted cardiac devices. The incidence of arrhythmias during the election was compared with a control period with Poisson regression. We also tested for effect modification by demographics, comorbidities, political affiliation, and whether an individual's political affiliation was concordant with county‐level election results. Overall, 2592 arrhythmic events occurred in 655 patients during the hazard period compared with 1533 events in 472 patients during the control period. There was a significant increase in the incidence of composite outcomes for any arrhythmia (incidence rate ratio [IRR], 1.77 [95% CI, 1.42–2.21]), supraventricular arrhythmia (IRR, 1.82 [95% CI, 1.36–2.43]), and ventricular arrhythmia (IRR, 1.60 [95% CI, 1.22–2.10]) during the election relative to the control period. There was also an increase in specific types of arrhythmia, including atrial fibrillation (IRR, 1.50 [95% CI, 1.06–2.11]), supraventricular tachycardia (IRR, 3.7 [95% CI, 2.2–6.2]), nonsustained ventricular tachycardia (IRR, 1.7 [95% CI, 1.3–2.2]), and daily atrial fibrillation burden (P<0.001). No significant interaction was found for sex, race/ethnicity, device type, age ≥65 years, hypertension, coronary artery disease, heart failure, political affiliation, or concordance between individual political affiliation and county‐level election results. Conclusions There was a significant increase in cardiac arrhythmias during the 2016 US presidential election. These findings suggest that exposure to stressful sociopolitical events may trigger arrhythmogenesis in susceptible people.
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Affiliation(s)
- Lindsey Rosman
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine The Miriam Hospital Providence RI.,Schools of Medicine and Public Health Brown University Providence RI
| | - Rafat Mahmood
- Department of Medicine University of North Carolina at Chapel Hill NC
| | - Hannan Yang
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Anthony J Mazzella
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Jeffrey Lawrence Klein
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Joseph Bumgarner
- Rex HospitalUniversity of North Carolina at Chapel Hill Health Raleigh NC
| | - Anil Gehi
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
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Cardiovascular Events After Partner Bereavement, What is the Role of Low Dose Aspirin and Beta-Blockers? Curr Probl Cardiol 2021; 47:100883. [PMID: 34103192 DOI: 10.1016/j.cpcardiol.2021.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/20/2022]
Abstract
Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.
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20
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Lewis TT, Van Dyke ME, Matthews KA, Barinas-Mitchell E. Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women. Am J Epidemiol 2021; 190:576-587. [PMID: 33034337 DOI: 10.1093/aje/kwaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.
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21
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Wang B, Xu H, Li C, Wang X, Sun W, Li J. Analysis of the Effect of Lyophilized Recombinant Human Brain Natriuretic Peptide on Endothelial Function in patients with acute myocardial infarction. Pak J Med Sci 2020; 37:99-103. [PMID: 33437258 PMCID: PMC7794129 DOI: 10.12669/pjms.37.1.2706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study aims to analyze the effect of lyophilized recombinant human brain natriuretic peptide on the endothelial function of patients with acute myocardial infarction. Methods One hundred and thirty-six patients with acute myocardial infarction in our hospital were randomly divided into a control group and an experimental group (68 cases each). The patients in the control group were treated by conventional treatment. The patients in the experimental group were treated with lyophilized recombinant human brain natriuretic peptide besides the conventional treatment. The levels of flow-mediated dilatation (FMD), serum nitric oxide (NO), and endothelin-1 were compared between the two groups before and after treatment. Results Before treatment, there was no significant difference between the two groups in the level of FMD (P>0.05); after treatment, the level of FMD in the experimental group was higher than that in the control group, and the difference was statistically significant (P<0.05); before treatment, there was no significant difference between the two groups in the levels of serum NO and endothelin-1 (P>0.05); after treatment, the levels of serum NO and endothelin-1 in the experimental group significantly improved, which were better than those in the control group (P<0.05). Conclusion Lyophilized recombinant human brain natriuretic peptide can improve the FMD, increase the content of NO in the blood, and effectively reduce the level of endothelin-1, which is of great significance to improve the endothelial function of patients with acute myocardial infarction and is worth clinical application.
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Affiliation(s)
- Bosong Wang
- Bosong Wang, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
| | - Hong Xu
- Hong Xu, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
| | - Chengqin Li
- Chengqin Li, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
| | - Xiaoding Wang
- Xiaoding Wang, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
| | - Weidong Sun
- Weidong Sun, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
| | - Jinlong Li
- Jinlong Li, Department of Cardiovascular III, Taian City Central Hospital, Taian, 271000, China
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22
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Yuki Miyamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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23
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Smid GE. A framework of meaning attribution following loss. Eur J Psychotraumatol 2020; 11:1776563. [PMID: 33244357 PMCID: PMC7678673 DOI: 10.1080/20008198.2020.1776563] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
The loss of a loved one causes the world and the place of the bereaved survivor in it to change irreversibly. A key aspect of the grieving process is the integration of the loss in the bereaved survivor's life story, identity change, and a new future orientation through meaning attribution. Meaning attribution can have favourable or unfavourable effects on the grieving process and hence determines the extent to which a loss disrupts the bereaved survivor's functioning. A framework of meaning attribution after loss is presented, comprising 17 determinants that fall into five categories: event-related, cultural, social, individual and relational determinants. Each determinant may lead to both positive and negative meanings, thereby facilitating or complicating the grieving process. The framework of meaning attribution highlights the importance of an integrated network for mental health care, spiritual care, and end-of-life care in the prevention and treatment of traumatic grief. It also emphasizes the support from relatives, collective rituals, cultural views, legal settlements, and other societal factors that may foster or impede adaptation to loss. The framework of meaning attribution informs research across a range of research themes, including specialist care for traumatic grief, a culturally sensitive care network for traumatic grief, and improving care for ambiguous loss in a global context.
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Affiliation(s)
- Geert E. Smid
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- University of Humanistic Studies, Utrecht, The Netherlands
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Ueda Y, Kosugi S, Abe H, Ozaki T, Mishima T, Date M, Uematsu M, Koretsune Y. Transient increase in blood thrombogenicity may be a critical mechanism for the occurrence of acute myocardial infarction. J Cardiol 2020; 77:224-230. [PMID: 32921530 DOI: 10.1016/j.jjcc.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 12/09/2022]
Abstract
Although the mechanism for the occurrence of acute myocardial infarction (MI) has been investigated by many pathological and clinical studies, it has not been adequately clarified yet. Although the disruption of vulnerable plaque is a well-known cause of acute MI, there are many silent plaque disruptions detected in the coronary artery by intravascular imaging studies. Therefore, many vulnerable plaques may disrupt and heal without causing acute MI. Some additional mechanisms other than the disruption of vulnerable plaque would be essential for the onset of acute MI. On the other hand, blood thrombogenicity would change dynamically due to circadian rhythms and many other factors. The combination of plaque and blood thrombogenicity would play an important and determinant role for the onset of acute MI.
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Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.
| | - Shumpei Kosugi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tatsuhisa Ozaki
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tsuyoshi Mishima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motoo Date
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yukihiro Koretsune
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Yu X, Zhang Y, Han P, Fu L, Chen X, Hou L, Song P, Zhao Y, Guo Q. Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study. J Int Med Res 2020; 48:300060520943450. [PMID: 32777962 PMCID: PMC7425277 DOI: 10.1177/0300060520943450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective Osteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese. Methods This study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis. Results In total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis. Conclusion Our results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.
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Affiliation(s)
- Xing Yu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Liyuan Fu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Lin Hou
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Peiyu Song
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Yong Zhao
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Abstract
The global movement toward legalization of cannabis is resulting in an ever-increasing public perception that cannabis is safe. Cannabis is not the first drug to be available for nonmedical use, nor is it the first to have such an unfounded safety profile. The safety of long-term exposure to phytocannabinoids is misunderstood by, and under reported to, the general public. There is evidence to suggest that long-term use of recreational cannabis may be associated with an increased risk of undesirable side effects. This evidence warrants both appropriate caution from the general public and investment in further research by government and industry sectors that are profiting from the sale of these potent psychoactive agents. There is no doubt that these compounds have medical potential. However, in addition to the medical potential, we must also remain aware of the adverse health effects that are becoming synonymous with recreational cannabis use. This perspective highlights the privileged role that cannabis has as a perceived “safe drug” in society and summarizes some concerning side effects that are becoming associated with regular nonprescribed cannabis use.
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Affiliation(s)
- Pauric Bannigan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - James C Evans
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Christine Allen
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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27
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Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief Before and After Bereavement in the Elderly: An Approach to Care. Am J Geriatr Psychiatry 2020; 28:560-569. [PMID: 32037292 DOI: 10.1016/j.jagp.2019.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses.
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Affiliation(s)
- Franziska Meichsner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt (FM), Frankfurt, Germany.
| | - Monique O'Connor
- Perth Clinic Medical Suites (MO), West Perth, Western Australia, Australia
| | - Natalia Skritskaya
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
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28
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Wei D, Janszky I, Ljung R, Leander K, Chen H, Fang F, Li J, László KD. Bereavement in the year before a first myocardial infarction: Impact on prognosis. Eur J Prev Cardiol 2020; 28:1229-1234. [PMID: 34551078 DOI: 10.1177/2047487320916958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/14/2021] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Death of the spouse in middle and old age is associated with an increased risk of cardiovascular and total mortality, particularly during the months after the loss. Knowledge regarding the effect of bereavement on prognosis in acute myocardial infarction (AMI) is limited. We analysed whether bereavement the year before the AMI is associated with prognosis.
Methods
We studied first AMI patients who participated in the Stockholm Heart Epidemiology Program (N = 1732). During or shortly after the hospitalization, patients or their family members completed a questionnaire regarding bereavement, sociodemographic, clinical and lifestyle factors; five months after their first infarction, surviving patients attended a clinical examination. Participants were followed for cardiovascular events and mortality for a median of 14 years.
Results
Overall bereavement, that is, death of a close friend or family member (including spouse/partner), the year before the first AMI was not associated with the combined outcome of non-fatal recurrent AMI and death due to ischaemic heart diseases. However, exposure to the loss of the spouse/partner was associated with an increased risk of the outcome (adjusted hazard ratio and (95% confidence interval): 1.55 (1.06–2.27)). We found no evidence that psychiatric disorders or blood lipids, glucose, coagulation and inflammatory markers mediated this association.
Conclusions
Loss of spouse/partner the year before the first AMI was associated with an increased risk of the combination of non-fatal recurrent AMI and death due to ischaemic heart disease. If confirmed by others, the findings may be informative for tertiary prevention of AMI.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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29
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Tofler GH, Morel-Kopp MC, Spinaze M, Dent J, Ward C, McKinley S, Mihailidou AS, Havyatt J, Whitfield V, Bartrop R, Fethney J, Prigerson HG, Buckley T. The effect of metoprolol and aspirin on cardiovascular risk in bereavement: A randomized controlled trial. Am Heart J 2020; 220:264-272. [PMID: 31923768 DOI: 10.1016/j.ahj.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bereavement is associated with an increased risk of cardiovascular disease; however, no reports exist of interventions to reduce risk. In a randomized, double-blind, placebo-controlled trial of 85 recently bereaved participants, we determined whether β-blocker (metoprolol 25 mg) and aspirin (100 mg) reduce cardiovascular risk markers and anxiety, without adversely affecting bereavement intensity. METHODS Participants were spouses (n = 73) or parents (n = 12) of deceased from 5 hospitals in Sydney, Australia, 55 females, 30 males, aged 66.1 ± 9.4 years. After assessment within 2 weeks of bereavement, subjects were randomized to 6 weeks of daily treatment or placebo, and the effect evaluated using ANCOVA, adjusted for baseline values (primary analysis). RESULTS Participants on metoprolol and aspirin had lower levels of home systolic pressure (P = .03), 24-hour average heart rate (P < .001) and anxiety (P = .01) platelet response to arachidonic acid (P < .001) and depression symptoms (P = .046) than placebo with no difference in standard deviation of NN intervals index (SDNNi), von Willebrand Factor antigen, platelet-granulocyte aggregates or bereavement intensity. No significant adverse safety impact was observed. CONCLUSIONS In early bereavement, low dose metoprolol and aspirin for 6 weeks reduces physiological and psychological surrogate measures of cardiovascular risk. Although further research is needed, results suggest a potential preventive benefit of this approach during heightened cardiovascular risk associated with early bereavement.
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Affiliation(s)
- Geoffrey H Tofler
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia.
| | - Marie-Christine Morel-Kopp
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia
| | - Monica Spinaze
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Jill Dent
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Christopher Ward
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | - Anastasia S Mihailidou
- Royal North Shore Hospital, St Leonards, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia; Macquarie University, Sydney, NSW, Autralia
| | - Jennifer Havyatt
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Victoria Whitfield
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Roger Bartrop
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | | | - Thomas Buckley
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Weill Cornell Medicine, New York, NY, U.S.A
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30
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Olliges E, Burgdorf C, Ladwig KH, Moeller C, Deftu-Kloes D, Pohl S, Ruettner B, Richardt G, Meissner K, Steger A, Goetzmann L, Ronel J. Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study. PSYCHOL HEALTH MED 2020; 25:989-1003. [PMID: 32000523 DOI: 10.1080/13548506.2020.1722315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.
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Affiliation(s)
- E Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - C Burgdorf
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen , Bad Bevensen, Germany
| | - K H Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum , Munich, Germany
| | - C Moeller
- Medical Clinic II, Luebeck, Universitaetsklinikum Schleswig-Holstein , Germany
| | - D Deftu-Kloes
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - S Pohl
- Psychiatric Day-care Hospital, Klinikum Frankfurt (Oder) , Frankfurt Oder, Germany
| | - B Ruettner
- Department of Psychology, Medical School Hamburg , Germany
| | - G Richardt
- Department of Cardiology, Segeberger Kliniken , Bad Segeberg, Germany
| | - K Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - A Steger
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich, Germany
| | - L Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG , Barmel- weid, Switzerland
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31
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Lee MJ, Lee TR, Lee SJ, Jang JS, Kim EJ. Machine Learning-Based Data Mining Method for Sentiment Analysis of the Sewol Ferry Disaster's Effect on Social Stress. Front Psychiatry 2020; 11:505673. [PMID: 33424646 PMCID: PMC7785789 DOI: 10.3389/fpsyt.2020.505673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
The Sewol Ferry Disaster which took place in 16th of April, 2014, was a national level disaster in South Korea that caused severe social distress nation-wide. No research at the domestic level thus far has examined the influence of the disaster on social stress through a sentiment analysis of social media data. Data extracted from YouTube, Twitter, and Facebook were used in this study. The population was users who were randomly selected from the aforementioned social media platforms who had posted texts related to the disaster from April 2014 to March 2015. ANOVA was used for statistical comparison between negative, neutral, and positive sentiments under a 95% confidence level. For NLP-based data mining results, bar graph and word cloud analysis as well as analyses of phrases, entities, and queries were implemented. Research results showed a significantly negative sentiment on all social media platforms. This was mainly related to fundamental agents such as ex-president Park and her related political parties and politicians. YouTube, Twitter, and Facebook results showed negative sentiment in phrases (63.5, 69.4, and 58.9%, respectively), entity (81.1, 69.9, and 76.0%, respectively), and query topic (75.0, 85.4, and 75.0%, respectively). All results were statistically significant (p < 0.001). This research provides scientific evidence of the negative psychological impact of the disaster on the Korean population. This study is significant because it is the first research to conduct sentiment analysis of data extracted from the three largest existing social media platforms regarding the issue of the disaster.
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Affiliation(s)
- Min-Joon Lee
- BK21PLUS Program in Embodiment: Health-Society Interaction, Department of Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Tae-Ro Lee
- BK21PLUS Program in Embodiment: Health-Society Interaction, School of Health Policy and Management, Korea University, Seoul, South Korea
| | - Seo-Joon Lee
- Research Institute of Health Science, Korea University, Seoul, South Korea
| | - Jin-Soo Jang
- Korea University Research Institute for Medical Bigdata Science, Korea University, Seoul, South Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
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32
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Shen Q, Jöud A, Schelin MEC, Sjölander A, Cao Y, Sparén P, Fall K, Czene K, Valdimarsdóttir U, Fang F. Psychiatric disorders and cardiovascular diseases during the diagnostic workup of potential breast cancer: a population-based cohort study in Skåne, Sweden. Breast Cancer Res 2019; 21:139. [PMID: 31823810 PMCID: PMC6902560 DOI: 10.1186/s13058-019-1232-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background An increasing number of women are evaluated for potential breast cancer and may experience mental distress during evaluation. We aim to assess the risks of psychiatric disorders and cardiovascular diseases during the diagnostic workup of potential breast cancer. Methods All women with a new diagnosis of unspecified lump in breast (N = 15,714), benign tumor or breast cancer in situ (N = 4435), or breast cancer (N = 8512) during 2005–2014 in Skåne, Sweden, were considered as exposed to a breast diagnostic workup. We used multivariable Poisson regression to compare rates of psychiatric disorders and cardiovascular diseases during the 6 weeks before the date of diagnosis of these women with the corresponding rates of women not undergoing such workup. The commonest waiting time for breast cancer patients was 6 weeks during the study period. A within-individual comparison was performed to control for potential unmeasured time-stationary confounders. Results Compared to the reference, we found a higher rate of psychiatric disorders during the 6 weeks before diagnosis of benign tumor or breast cancer in situ (incidence rate ratio [IRR], 1.3; 95% confidence interval [CI], 1.1 to 1.5) and breast cancer (IRR, 1.4; 95% CI, 1.2 to 1.6). A higher rate was also noted for cardiovascular diseases (IRR, 1.3; 95% CI, 1.1 to 1.6 for benign tumor or breast cancer in situ, and IRR, 1.9; 95% CI, 1.8 to 2.0 for breast cancer). The rate increases for breast cancer were greater comparing a diagnostic workup due to symptoms to a workup due to screening. Little rate increase of neither psychiatric disorders nor cardiovascular diseases was noted during the 6 weeks before the diagnosis of unspecified lump in breast. The within-individual comparison largely confirmed these findings. Conclusions Women with benign and malignant breast tumor had increased rates of psychiatric disorders and cardiovascular diseases during the waiting for a final diagnosis.
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Affiliation(s)
- Qing Shen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.
| | - Anna Jöud
- Epidemiology and Register Centre South, Region Skåne, SE-221 85, Lund, Sweden.,Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, SE-221 00, Lund, Sweden
| | - Maria E C Schelin
- Epidemiology and Register Centre South, Region Skåne, SE-221 85, Lund, Sweden.,Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, SE-221 00, Lund, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE-701 82, Örebro, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE-701 82, Örebro, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden
| | - Unnur Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.,Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, MA, 02115, USA.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.
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Sharkey SW, Kalra A, Henry TD, Smith TD, Pink VR, Lesser JR, Garberich RF, Maron MS, Maron BJ. Coexistence of acute takotsubo syndrome and acute coronary syndrome. Catheter Cardiovasc Interv 2019; 96:825-829. [PMID: 31696663 DOI: 10.1002/ccd.28595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo syndrome (TS) is an acute cardiac condition with presentation indistinguishable from acute coronary syndrome (ACS), and mechanism independent of epicardial coronary obstruction. Acute coronary artery plaque rupture/occlusion is not expected in TS. Nonetheless, the physiologic stress of ACS might itself trigger TS, leading to coexistence of both conditions, and diagnostic uncertainty. METHODS From 2011 to 2014, we encountered 137 consecutive patients with typical TS (without acute coronary plaque rupture/occlusion). During this time, among a population of 3,506 consecutive ACS patients, nine (0.3%) presented with features of both ACS and TS, that is, acute onset, troponin elevation, acute plaque rupture/occlusion, and reversible LV ballooning not corresponding to culprit coronary distribution. RESULTS The nine patients (seven female) with TS-ACS coexistence, average age 70 ± 13 years, presented with chest pain (n = 6), nausea/vomiting (n = 2), or cardiac arrest (n = 1), ST-elevation (n = 5), all with troponin elevation (peak 1.3 ± 1.2 ng/ml). Each had single vessel coronary disease; right coronary (n = 3), circumflex (n = 3), mid-LAD (n = 2), ramus intermedius (n = 1), with percutaneous coronary intervention in seven patients (78%). Initial ejection fraction was 26 ± 7%, with apical ballooning in eight patients and mid-LV ballooning in one patient. Each patient had LV ballooning resolution and ejection fraction normalization to 57 ± 3%, hospital survival was 89%. CONCLUSIONS Among patients with ACS, a subset have evidence of coexisting TS, findings which further expand the clinical profile of both conditions, raising the possibility that ACS itself may trigger TS.
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Affiliation(s)
- Scott W Sharkey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ankur Kalra
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.,Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Timothy D Smith
- Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Victoria R Pink
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - John R Lesser
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ross F Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - Barry J Maron
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.,Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVE Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development. METHODS Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms. RESULTS Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence. CONCLUSIONS Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.
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Harashima S, Fujimori M, Akechi T, Matsuda T, Saika K, Hasegawa T, Inoue K, Yoshiuchi K, Miyashiro I, Uchitomi Y, Matsuoka YJ. Suicide, other externally caused injuries and cardiovascular death following a cancer diagnosis: study protocol for a nationwide population-based study in Japan (J-SUPPORT 1902). BMJ Open 2019; 9:e030681. [PMID: 31278108 PMCID: PMC6615787 DOI: 10.1136/bmjopen-2019-030681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION A growing body of literature has demonstrated that cancer patients have a higher risk of suicide and cardiovascular mortality compared with the general population, especially immediately after a cancer diagnosis. Using data from the National Cancer Registry in Japan launched in January 2016, we will conduct the first nationwide population-based study in Japan to compare incidence of death by suicide, other externally caused injuries (ECIs) and cardiovascular disease following a cancer diagnosis with that of the general population in Japan. We will also aim to identify the patient subgroups and time periods associated with particularly high risk. METHODS AND ANALYSIS Our study subjects will consist of cancer cases diagnosed between 1 January 2016 and 31 December 2016 in Japan and they will be observed until 31 December 2018. We will calculate standardised mortality ratios (SMRs) and excess absolute risks (EARs) for suicide, other ECIs and cardiovascular death compared with the general population in Japan, after adjustment for sex, age and prefecture. SMRs and EARs will be calculated separately in relation to a number of factors: sex; age at diagnosis; time since cancer diagnosis; prefecture of residence at diagnosis; primary tumour site; behaviour code of tumour; extension of tumour; whether definitive surgery of the primary site was performed; and presence/absence of multiple primary tumours. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board and ethics committee of the National Cancer Center Japan and Nagoya City University Graduate School of Medical Sciences. The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER UMIN000035118; Pre-results.
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Affiliation(s)
- Saki Harashima
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Kumiko Saika
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takaaki Hasegawa
- Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Keisuke Inoue
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Abstract
OBJECTIVE Bereavement is associated with increased risk for morbidity and all-cause mortality across epidemiological, meta-analytic, and case-control studies. The body of research examining the association between bereavement and immune function, beginning in 1977, has yet to be reviewed. The current systematic review clarifies these findings, identifies limitations of the diverse literature, and suggests a model and directions for future research. METHODS The PRISMA guidelines for systematic reviews were used to synthesize 41 years of research. Compared with a meta-analysis, a systematic review is appropriate given the heterogeneous nature of the studies. We used the National Heart, Lung, and Blood Institute Study Quality Assessment Tool to assess the quality of select studies. RESULTS Thirty-three publications met inclusion criteria. Most studies support the association between bereavement and maladaptive changes in immune parameters in adults, with mixed findings on bereavement-related changes in cellular immunity. A handful of recent, good-quality studies show bereaved people demonstrate higher levels of systemic inflammation, maladaptive immune cell gene expression, and lower antibody response to vaccination compared with nonbereaved controls. Individual differences in psychological response to bereavement (e.g., depression, grief) seem to influence the association between bereavement and immune function. CONCLUSIONS Research examining the association between bereavement and biomarkers of immune function is heterogeneous in methods and quality. Despite these limitations, there is evidence supporting maladaptive changes in immune function after bereavement. The research area would benefit from longitudinal research with larger sample sizes, advanced immunological methods, and incorporating measures of psychological responses to bereavement. The field is poised to refine and scale up its investigation of this common and important phenomenon.
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Chen MA, Lewis MR, Chirinos DA, Murdock KW, Fagundes C. Differential psychological reactions to grief: The role of childhood adversity for depression symptoms among bereaved and non-bereaved adults. DEATH STUDIES 2019; 44:778-786. [PMID: 31094661 PMCID: PMC6858533 DOI: 10.1080/07481187.2019.1614107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Childhood maltreatment dysregulates an individual's physiological response to stress, increasing reactivity to stressors across the lifespan. Given the prevalence and impact of bereavement, we examined whether the association between childhood maltreatment and depression was exacerbated by spousal bereavement. We identified an interaction between childhood maltreatment and bereavement using linear regression analysis (B = 0.79, p < .001). A simple slopes test indicated a positive association between childhood maltreatment and depressive symptoms among those who were bereaved (B = 0.86, p < .001), but such association did not emerge among those who were not bereaved (B = 0.06, p = .60).
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Affiliation(s)
- Michelle. A. Chen
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
| | - Megan R. Lewis
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Medicine, Dell Medical School, 1501 Red River Street, Austin, TX 78712
| | - Diana A. Chirinos
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL 60611
| | - Kyle W. Murdock
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Christopher Fagundes
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030
- Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Ghiasmand M, Moghadamnia MT, Pourshaikhian M, Kazemnezhad Leyli E. Emotional Triggers of Acute Myocardial Infarction. JOURNAL OF HOLISTIC NURSING AND MIDWIFERY 2019. [DOI: 10.29252/hnmj.29.1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Campos MTFDS, Valente FMQ, Araújo RMA, Bressan J. Mourning and Takotsubo cardiomyopathy: neuroendocrine implications and nutritional management. Rev Assoc Med Bras (1992) 2018; 64:952-959. [PMID: 30517244 DOI: 10.1590/1806-9282.64.10.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 11/21/2022] Open
Abstract
This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.
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Affiliation(s)
| | | | - Raquel Maria Amaral Araújo
- Associated Professor. Department of Nutrition and Health - DNS, Federal University of Viçosa (UFV), campus Viçosa, Viçosa (MG), Brasil
| | - Josefina Bressan
- Senior Professor. Department of Nutrition and Health/UFV. Post-Graduation Program of Nutrition Sciences, Federal University of Viçosa, Viçosa (MG), Brasil
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Saarela J, Rostila M. Mortality after the death of a parent in adulthood: a register-based comparison of two ethno-linguistic groups. Eur J Public Health 2018; 29:5094540. [PMID: 30204863 PMCID: PMC6532953 DOI: 10.1093/eurpub/cky189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most research on parental bereavement and health have analysed health consequences of parental loss in childhood, while collateral health in adulthood has been less studied. METHODS Using register-based population data from Finland, we analyse adult offspring aged 18-50 years with discrete-time hazard models that adjust for offspring and parental socioeconomic and demographic characteristics. In focus are adult children whose parents were alive and lived together at the beginning of the observation period. We compare two culturally distinct but otherwise similar ethno-linguistic groups, Finnish speakers and Swedish speakers. RESULTS The results suggest that bereaved men have an approximately 30% higher death risk than non-bereaved men, while there is practically no difference in women. Associations between parental and child deaths are, as expected, stronger for concordant causes of death than for discordant causes of death. However, some associations for discordant causes of death remain, which may indicate causality. Among Swedish speakers, who have notably higher family stability than Finnish speakers, the death of one or both parents shows a stronger association with own mortality. CONCLUSIONS The estimated associations found are generally larger than in the neighbouring country Sweden, which may be due to a stronger obedience to traditional family values and patriarchal family roles in Finland. These findings suggest that the association between parental death and mortality in adult offspring may depend on the societal context as well as on cultural practices. These factors should be increasingly acknowledged in future studies on collateral health.
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Affiliation(s)
- Jan Saarela
- Demography Unit, Åbo Akademi University, Vaasa, Finland
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Zhang Y, Liu X, Zhang L, Li X, Zhou Z, Jiao L, Shao Y, Li M, Leng B, Zhou Y, Liu T, Liu Q, Shan H, Du Z. Metformin Protects against H 2O 2-Induced Cardiomyocyte Injury by Inhibiting the miR-1a-3p/GRP94 Pathway. MOLECULAR THERAPY. NUCLEIC ACIDS 2018; 13:189-197. [PMID: 30292140 PMCID: PMC6172474 DOI: 10.1016/j.omtn.2018.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 01/30/2023]
Abstract
Ischemia-reperfusion (I/R) injury is a major side effect of the reperfusion treatment of the ischemic heart. Few therapies are available for the effective prevention of this injury caused by the oxidative stress-induced cardiomyocyte apoptosis. Metformin was shown to have a potential cardiac protective effect and ability to reduce cardiac events, but the exact mechanism remains unclear. Here, we aimed to confirm and investigate the mechanisms underlying potential metformin activity against I/R injury in response to oxidative stress. We determined that the expression of miR-1a-3p was significantly increased in neonatal rat ventricular cells (NRVCs), which were exposed to H2O2in vitro and in the hearts of mice that underwent the I/R injury. MiR-1a-3p was shown to target the 3′ UTR of GRP94, which results in the accumulation of un- or misfolded proteins, leading to the endoplasmic reticulum (ER) stress. The obtained results demonstrated that C/EBP β directly induces the upregulation of miR-1a-3p by binding to its promoter. Furthermore, as a direct allosteric AMPK activator, metformin was shown to activate AMPK and significantly reduce C/EBP β and miR-1a-3p levels compared with those in the control group. In conclusion, metformin protects cardiomyocytes against H2O2 damage through the AMPK/C/EBP β/miR-1a-3p/GRP94 pathway, which indicates that metformin may be applied for the treatment of I/R injury.
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Affiliation(s)
- Ying Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xue Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Lu Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xuelian Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Zhongqiu Zhou
- Institute of Clinical Pharmacy, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Lei Jiao
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yingchun Shao
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Mengmeng Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Bing Leng
- Pharmacy Intravenous Admixture Service, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yuhong Zhou
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Tianyi Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China; Department of Pharmaceutics, Dalian Children's Hospital, Dalian, Liaoning 116001, P.R. China
| | - Qiushuang Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Hongli Shan
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China.
| | - Zhimin Du
- Institute of Clinical Pharmacy, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China.
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Shahane AD, Fagundes CP, Denny BT. Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement. BEREAVEMENT CARE : FOR ALL THOSE WHO HELP THE BEREAVED 2018; 37:44-54. [PMID: 31548757 PMCID: PMC6756769 DOI: 10.1080/02682621.2018.1493640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.
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Affiliation(s)
| | - Christopher P. Fagundes
- Rice University, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Baylor College of Medicine, Houston, TX
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Fuchs-Strizek R, Berger T. Psychokardiologie in der stationären Rehabilitation. Wien Med Wochenschr 2018; 168:31-38. [DOI: 10.1007/s10354-017-0606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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Rodríguez-Álvaro M, Brito-Brito PR, García-Hernández AM, Aguirre-Jaime A, Fernandez-Gutierrez DA. The Grieving Nursing Diagnoses in the Primary Healthcare Setting. Int J Nurs Knowl 2018; 30:34-42. [PMID: 29360242 DOI: 10.1111/2047-3095.12202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To estimate the prevalence of Grieving, risk for Complicated Grieving, and Complicated Grieving in the primary care setting. METHODS Retrospective epidemiological study, analyzing data from electronic health records (EHR). FINDINGS A total of 84% of the 9,063 records had diagnostic labels without defining characteristics, related factors, or risk factors. A larger frequency of complicated grieving was found in deceased mourners. CONCLUSIONS The grieving epidemiology opens new chances for the research using data from EHR. PRACTICE IMPLICATIONS The adequacy of the records is essential to develop a profile of the patient at risk of complications after the loss. This research is an important step to build an epidemiological basis for nursing diagnosis of grieving in the primary health care setting.
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Schultz WM, Hayek SS, Samman Tahhan A, Ko YA, Sandesara P, Awad M, Mohammed KH, Patel K, Yuan M, Zheng S, Topel ML, Hartsfield J, Bhimani R, Varghese T, Kim JH, Shaw L, Wilson P, Vaccarino V, Quyyumi AA. Marital Status and Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2017; 6:e005890. [PMID: 29263033 PMCID: PMC5778993 DOI: 10.1161/jaha.117.005890] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. METHODS AND RESULTS A prospective cohort (inception period 2003-2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7-6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular-related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06-1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18-1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27-1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10-1.81), widowed (HR: 1.71; 95% CI, 1.32-2.20), or never married (HR: 1.40; 95% CI, 0.97-2.03). The findings persisted after adjustment for medications and other socioeconomic factors. CONCLUSIONS Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.
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Affiliation(s)
- William M Schultz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ayman Samman Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Mosaab Awad
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Kareem H Mohammed
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
| | - Shuai Zheng
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Matthew L Topel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Joy Hartsfield
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ravila Bhimani
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Tina Varghese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
- American Institutes for Research, Washington, DC
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
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Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Health-related quality of life and risk of composite coronary heart disease and cerebrovascular events in the Moli-sani study cohort. Eur J Prev Cardiol 2017; 25:287-297. [PMID: 29243510 DOI: 10.1177/2047487317748452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background To assess the association between health-related quality of life (HRQL) and a composite outcome including incident coronary heart disease (CHD) and cerebrovascular events in a large general population-based cohort. Design Prospective analysis on 17,102 men and women (mean age 53 ± 11) free from cardiovascular disease at time of enrolment in the Moli-sani cohort (2005-2010). Methods HRQL was assessed by the 36-Item Short Form Health Survey. Hazard ratios with 95% confidence intervals (95% CIs) were calculated using multivariable Cox-proportional hazard models. Results At the end of follow-up (median 4.2 years), 237 new events occurred (coronary heart disease n = 197, cerebrovascular disease n = 42). In a multivariable model adjusted for socioeconomic factors, chronic disease and health-related behaviours, both mental and physical HRQL were inversely associated with the risk of the composite outcome (hazard ratio = 0.57; 0.39-0.84 and hazard ratio = 0.62; 0.40-0.94, respectively; highest vs. lowest quartile). Further adjustment for C-reactive protein marginally modified the association with physical HRQL (hazard ratio = 0.67; 0.43-1.02). Similar findings were obtained when only CHD events were analysed (hazard ratio = 0.63; 0.41-0.96 for highest versus lowest mental HRQL) although results with physical HRQL were no longer significant (hazard ratio = 0.65; 0.40-1.04 for highest versus lowest quartile). Associations with incident cerebrovascular disease showed a trend toward protection (hazard ratio = 0.50; 0.22-1.17 and hazard ratio = 0.51; 0.22-1.23 for highest versus lowest tertile of mental and physical HRQL, respectively). Conclusions HRQL is an independent predictor of composite CHD/cerebrovascular outcomes in an adult population. The magnitude of the association was not affected either by socioeconomic factors, health conditions or health-related behaviours. Improvement of quality of life may be a major factor in targeting appropriate prevention strategies for cardiovascular health.
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Affiliation(s)
- Marialaura Bonaccio
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Augusto Di Castelnuovo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Simona Costanzo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Mariarosaria Persichillo
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Amalia De Curtis
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Chiara Cerletti
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Maria Benedetta Donati
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Giovanni de Gaetano
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Licia Iacoviello
- 1 Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.,2 Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
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Ghiasmand M, Moghadamnia MT, Pourshaikhian M, Kazemnejad Lili E. Acute triggers of myocardial infarction: A case-crossover study. Egypt Heart J 2017; 69:223-228. [PMID: 29622981 PMCID: PMC5883494 DOI: 10.1016/j.ehj.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/16/2017] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is one of the most preventable non-communicable diseases in human. Identifying triggers of myocardial infarction (MI) and prevention ways of exposure-induced complications can reduce morbidity and mortality in people at risk. AIM The aim of this study was to identify the emotional, environmental, physical and chemical dimensions of acute triggers in patients with AMI. METHODS This case-crossover study was conducted on 269 patients with AMI, hospitalized at two remedial centers in Rasht in 2015. The study samples were selected by convenient sampling method. Data were collected using researcher-made questionnaire through interviews. Hazard and control periods for each trigger and its effects on the development of MI were studied. The collected data were analyzed using descriptive and analytical statistical methods, Cochran test, and generalized estimating equation (GEE) model with logistics function default in SPSS version 21, and p < 0.05 was considered statistically significant. RESULTS The results showed that quarrel (P = 0.008, OR = 2.01) and hearing the sudden news (P = 0.001, OR = 2.19) were the most common emotional triggers. Respiratory infections (P = 0.0001, OR = 6.78) and exposure to hot or cold weather (P = 0.005, OR = 2.19) were the most frequent environmental triggers. Doing heavy activities (P = 0.005, OR = 1.66) and sexual activities (P = 0.003, OR = 2.36) were among the most common physical triggers. High-fat foods consumption and overeating (P = 0.0001, OR = 3.79) were the most frequent chemical triggers of AMI. CONCLUSION It seems that given the importance of the triggers in the incidence of AMI, planning is necessary to train vulnerable individuals to reduce exposure to triggers.
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Affiliation(s)
- Maryam Ghiasmand
- Guilan Social Security Organization, Rasool-e-Akram Hospital, Rasht, Iran
| | - Mohammad Taghi Moghadamnia
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nursing (Medical-Surgical), Instructor, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Majid Pourshaikhian
- Department of Operating Room & Anesthesia, Paramedical School, Guilan University of Medical Sciences, Rasht, Iran
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