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Hazuda HP, Gaussoin SA, Wing RR, Yanovski SZ, Johnson KC, Coday M, Wadden TA, Horton ES, Van Dorsten B, Knowler WC. Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes. Diabetes Care 2019; 42:910-918. [PMID: 30833373 PMCID: PMC6489104 DOI: 10.2337/dc18-0575] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score <10 or ≥10). ADM use was coded from participants' prescription medications. Four composite CVD outcomes were defined in the study protocol. Sex-stratified Cox proportional hazards models were adjusted for a range of baseline covariates. RESULTS Depression symptoms were only significantly associated with a composite secondary outcome comprising CVD death, nonfatal myocardial infarction, nonfatal stroke, hospitalized angina, congestive heart failure, peripheral vascular disease, coronary artery bypass graft, and carotid endarterectomy. Significant sex interactions were observed for BDI score and BDI score ≥10. BDI score was significantly associated with higher probability of this composite outcome in men but was not associated with the outcome in women. BDI score ≥10 was positively associated with this composite outcome in men but was negatively associated in women. Exploratory analysis identified a significant BDI ≥10 × ADM use interaction for this composite outcome that differed in men versus women. Men with both BDI score ≥10 and ADM use compared with those with neither had 60% higher probability of the outcome, whereas women with both compared with those with neither had 50% lower probability. CONCLUSIONS Sex differences in the association of depression symptoms and ADM use with incident CVD warrant further investigation.
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Affiliation(s)
- Helen P Hazuda
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Rena R Wing
- The Miriam Hospital/Brown Medical School, Providence, RI
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Mace Coday
- The University of Tennessee, Memphis, TN
| | | | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Steca P, Monzani D, Greco A, Franzelli C, Magrin ME, Miglioretti M, Sarini M, Scrignaro M, Vecchio L, Fattirolli F, D’Addario M. Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event. PLoS One 2017; 12:e0183905. [PMID: 28850579 PMCID: PMC5574544 DOI: 10.1371/journal.pone.0183905] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur. Purpose The aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach. Methods Two hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed. Results Patients' diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation. Conclusions Current findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients.
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Affiliation(s)
- Patrizia Steca
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
| | - Dario Monzani
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
- * E-mail:
| | - Andrea Greco
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
| | - Cristina Franzelli
- Cardiac Rehabilitation Centre, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| | | | | | - Marcello Sarini
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
| | - Marta Scrignaro
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
| | - Luca Vecchio
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
| | - Francesco Fattirolli
- Department of Medical and Surgical Critical Care, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco D’Addario
- Department of Psychology, University of Milan –Bicocca, Milan, Italy
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Spontaneous Coronary Artery Dissection in Pregnancy: What Every Obstetrician Should Know. Obstet Gynecol 2017; 128:731-738. [PMID: 27607875 DOI: 10.1097/aog.0000000000001630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Spontaneous coronary artery dissection is a major cause of myocardial infarction in pregnancy and the postpartum period. It occurs predominantly in young women with few or no conventional risk factors for atherosclerosis and has been clinically underrecognized. Treatment differs from that of myocardial infarction as a result of atherosclerosis and the diagnosis should be considered in all parturient and postpartum patients with acute coronary syndrome. Complications of spontaneous coronary artery dissection include recurrence, congestive heart failure, and death. Thus, specialist obstetrician-gynecologists and maternal-fetal medicine specialists need to gain knowledge of spontaneous coronary artery dissection to improve outcomes.
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Dog Ownership and Dog Walking: The Relationship With Exercise, Depression, and Hopelessness in Patients With Ischemic Heart Disease. J Cardiovasc Nurs 2017; 33:E7-E14. [PMID: 28489725 DOI: 10.1097/jcn.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dog ownership has been associated with increased physical activity in the general adult population. OBJECTIVE The objective of this study was to examine dog ownership and dog walking and their relationship with home-based and phase II cardiac rehabilitation exercise, depression, and hopelessness in patients with ischemic heart disease. METHODS A total of 122 patients with ischemic heart disease were included in this prospective observational study. Patients completed dog ownership/walking questions during their hospitalization. The Cardiac Rehabilitation Exercise Participation Tool, Patient Health Questionnaire-9, and State-Trait Hopelessness Scale were completed by mail at 3, 8, or 12 months later. Regression modeling was used to evaluate the significance of dog ownership/walking on exercise, depression and hopelessness. RESULTS The sample was 34.4% female and had a mean age of 64.7 ± 9.1 years. Forty-two patients (34.4%) reported owning a dog. Patients who owned but did not walk their dog reported significantly lower levels of home exercise compared with patients who walked their dogs at least 1 day per week (36.8% for non-dog walkers vs 73.9% for dog walkers, P = .019). The odds of participating in home exercise were significantly higher for dog walkers compared with non-dog walkers (odds ratio, 8.1 [1.7, 38.5] vs 1.0). There were no differences in phase II cardiac rehabilitation exercise, depression, or hopelessness between dog owners and non-dog owners or between dog walkers and non-dog walkers. CONCLUSIONS These findings show a beneficial effect on home-based exercise for those who dog-walk at least 1 day per week. Healthcare professionals should encourage dog walking to increase dog owners' physical activity levels.
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Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Prefer Adherence 2017; 11:547-559. [PMID: 28352161 PMCID: PMC5359120 DOI: 10.2147/ppa.s127277] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Correspondence: Carly M Goldstein, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA, Tel +1 401 793 8960, Fax +1 401 793 8944, Email
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Sarah Garcia
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Prevalence and predictors of depression and anxiety among survivors of myocardial infarction due to spontaneous coronary artery dissection. J Cardiopulm Rehabil Prev 2014; 34:138-42. [PMID: 24280906 DOI: 10.1097/hcr.0000000000000030] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Depression and anxiety after myocardial infarction (MI) are common and associated with increased morbidity and mortality. The epidemiology and pathophysiology of MI due to spontaneous coronary artery dissection (SCAD) differs substantially from atherosclerotic MI, and rates of mental health comorbidities after SCAD are unknown. We aimed to determine the prevalence and predictors of depression/anxiety in SCAD survivors. METHODS In this cross-sectional study, 158 SCAD survivors (97% women; mean age, 45.5 ± 9.3 years) were screened for depression/anxiety via surveys, including the Patient Health Questionnaire Depression Scale (PHQ-9) and Generalized Anxiety Disorder 7-Item Scale (GAD-7), a mean 3.7 ± 4.7 years after SCAD. Comorbidities and environmental, socioeconomic, and clinical cardiovascular characteristics were obtained from the surveys. RESULTS Since their initial SCAD MI, 51 (33%) patients had received treatment with medications or counseling for depression and 57 (37%) for anxiety. When surveyed, 46 (31.7%) were taking antidepressant or anxiolytic medications. Overall, mean PHQ-9 (4.1) and GAD-7 (4.7) scores suggested borderline mild depression/anxiety (normal range: 0-4). Younger age was associated with higher PHQ-9 (P = .04) and GAD-7 (P = .02) scores. The 19 (12%) patients with peripartum SCAD had higher mean PHQ-9 (6.7 vs 3.7; P < .0005) and GAD-7 (8.1 vs 4.3; P = .003) scores. Patients treated with percutaneous coronary intervention had lower PHQ-9 (1.5; P = .02) and GAD-7 (2.4; P = .004) scores. CONCLUSIONS Symptoms of depression/anxiety are common in patients with MI due to SCAD, particularly younger women and those with peripartum SCAD. The PHQ-9 and GAD-7 assessments may detect depression/anxiety in SCAD survivors who do not self-report these disorders, suggesting a role for routine screening in these patients.
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Friedewald VE, Hayes SN, Pepine CJ, Roberts WC, Wenger NK. The Editor's Roundtable: The 10Q Report - Advancing women's heart health through improved research, diagnosis, and treatment. Am J Cardiol 2013; 112:1676-87. [PMID: 24157193 DOI: 10.1016/j.amjcard.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Vincent E Friedewald
- Associate Editor, The American Journal of Cardiology, Clinical Professor of Medicine, University of Texas-Houston Health Science Center, Houston, Texas, and Adjunct Research Professor, Indiana University School of Medicine, South Bend, Indiana.
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Eliminating untimely deaths of women from heart disease: highlights from the Minnesota Women's Heart Summit. Am Heart J 2012; 163:39-48.e1. [PMID: 22172435 DOI: 10.1016/j.ahj.2011.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/26/2011] [Indexed: 11/20/2022]
Abstract
Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains their leading cause of death, annually killing more women than men. Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning. The Minnesota Women's Heart Summit was convened to chart a course to eliminate premature deaths of women from heart disease. The multidisciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic. Presentations highlighted sex-based differences in symptoms, treatment, and outcomes, and panel experts provided commentary. Invited faculty and summit participants worked in small-group sessions to identify strategies to dissolve barriers, improve primary and secondary prevention, and enhance women's care and outcomes. This report summarizes strategies identified during the conference to serve as springboards for more substantive future initiatives. These include, for example, standardized data collection and use of existing data sets to inform perspectives on sex-related cardiovascular issues, mandatory reporting of sex-specific data, and increased attention to underserved/high-risk women. Participants acknowledged that implementing these ideas would be challenging and recommended key priorities/next action steps such as providing services close to "point-of-life" rather than "point-of-care" and creation of policies and regulations so that resources and environmental modifications encouraging healthier lifestyle choices are promoted. Additional research is needed to improve identification, treatment, and health behaviors and to address continued lack of awareness, symptom recognition delays, barriers to care, and outcome disparities-especially in diverse populations.
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Abstract
Incidence and rate of cardiovascular disease differ between men and women across the life span. Although hypertension is more prominent in men than women, there is a group of vasomotor disorders [i.e. Raynaud's disease, postural orthostatic tachycardia syndrome and vasomotor symptoms (hot flashes) of menopause and migraine] with a female predominance. Both sex and hormones interact to modulate neuroeffector mechanisms including integrated regulation of the Sry gene and direct effect of sex steroid hormones on synthesis, release and disposition of monoamine neurotransmitters, and distribution and sensitivity of their receptors in brain areas associated with autonomic control. The interaction of the sex chromosomes and steroids also modulates these effector tissues, that is, the heart, vascular smooth muscle and endothelium. Although involvement of central serotonergic centres has been studied in regard to mood disorders such as depression, their contribution to cardiovascular risk is gaining attention. Studies are needed to further evaluate how hormonal treatments and drugs used to modulate adrenergic and serotonergic activity affect progression and risk for cardiovascular disease in men and women.
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Affiliation(s)
- Emma C. Hart
- Department of Anesthesia, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nisha Charkoudian
- Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M. Miller
- Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
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