Effect of Stress, Depression and Type D Personality on Immune System in the Incidence of Coronary Artery Disease

Depression and coronary heart disease: mechanisms, interventions, and treatments

Coronary heart disease (CHD), a cardiovascular condition that poses a significant threat to human health and life, has imposed a substantial economic burden on the world. However, in contrast to conventional risk factors, depression emerges as a novel and independent risk factor for CHD. This condition impacts the onset and progression of CHD and elevates the risk of adverse cardiovascular prognostic events in those already affected by CHD. As a result, depression has garnered increasing global attention. Despite this growing awareness, the specific mechanisms through which depression contributes to the development of CHD remain unclear. Existing research suggests that depression primarily influences the inflammatory response, Hypothalamic-pituitary-adrenocortical axis (HPA) and Autonomic Nervous System (ANS) dysfunction, platelet activation, endothelial dysfunction, lipid metabolism disorders, and genetics, all of which play pivotal roles in CHD development. Furthermore, the effectiveness and safety of antidepressant treatment in CHD patients with comorbid depression and its potential impact on the prognosis of CHD patients have become subjects of controversy. Further investigation is warranted to address these unresolved questions.

Erzhiwan Ameliorates Restraint Stress- and Monobenzone-Induced Depigmentation in Mice by Inhibiting Macrophage Migration Inhibitory Factor and 8-Hydroxy-2-Deoxyguanosine

Purpose

Vitiligo is an autoimmune disease that results in the loss of epidermal melanocytes. The treatments for patients with vitiligo remain lacking. Erzhiwan (EZW), a traditional Chinese Medicine composed of Ligustri Lucidi Fructus and Ecliptae Herba, was used to ameliorate depigmentation since ancient China. This study aims to investigate the effect of EZW on vitiligo-related depigmentation.

Methods

A vitiligo-related depigmentation mouse model was induced by monobenzone and restraint stress. The experimental depigmentation mice were treated with EZW. Histological observation of skin was conducted. Cutaneous oxidative damage and inflammation were determined. A network pharmacology analysis was carried out.

Results

EZW reduced depigmentation score (p<0.01), cutaneous inflammatory infiltration (p<0.01), and CD8α-positive expression (p<0.01), and increased cutaneous melanin content in experimental depigmentation mice. EZW reduced stress reaction in experimental depigmentation mice (p<0.01). EZW inhibited 8-hydroxy-2-deoxyguanosine (8-OHdG)-related DNA oxidative damage in the skin (p<0.05, p<0.01). In addition, EZW reduced cutaneous macrophage migration inhibitory factor (MIF)-CD74-NF-κB signaling (p<0.01). The network pharmacology analysis demonstrated that EZW regulated necroptosis, apoptosis, and FoxO signaling pathways in vitiligo. An in vitro experiment showed that the main ingredient of EZW, specnuezhenide, protected against monobenzone and MIF-induced cell death in HaCaT cells (p<0.01).

Conclusion

EZW ameliorates restraint stress- and monobenzone-induced depigmentation via the inhibition of MIF and 8-OHdG signaling. The findings provide a data basis of an utilization of EZW in vitiligo.

Architectural Allostatic Overloading: Exploring a Connection between Architectural Form and Allostatic Overloading

This paper examines, conceptually, the relationship between stress-inducing architectural features and allostatic overload by drawing on literature from neuroimmunology and neuroarchitecture. The studies reviewed from the field of neuroimmunology indicate that chronic or repeated exposure to stress-inducing events may overwhelm the body's regulatory system, resulting in a process termed allostatic overload. While there is evidence from the field of neuroarchitecture that short-term exposure to particular architectural features produce acute stress responses, there is yet to be a study on the relationship between stress-inducing architectural features and allostatic load. This paper considers how to design such a study by reviewing the two primary methods used to measure allostatic overload: biomarkers and clinimetrics. Of particular interest is the observation that the clinical biomarkers used to measure stress in neuroarchitectural studies differ substantially from those used to measure allostatic load. Therefore, the paper concludes that while the observed stress responses to particular architectural forms may indicate allostatic activity, further research is needed to determine whether these stress responses are leading to allostatic overload. Consequently, a discrete longitudinal public health study is advised, one which engages the clinical biomarkers indicative of allostatic activity and incorporates contextual data using a clinimetric approach.

Depression trajectories during the COVID-19 pandemic in the high-quality health care setting of Switzerland: the COVCO-Basel cohort

OBJECTIVES

During the pandemic, Switzerland avoided stringent lockdowns and provided funds to stabilize the economy. To assess whether and in what subgroups the pandemic impacted on depressive symptoms in this specific Swiss context, we derived depression trajectories over an extended pandemic period in a Swiss cohort and related them to individuals' sociodemographic characteristics.

STUDY DESIGN

This was a population-based cohort study.

METHODS

The population-based COVCO-Basel cohort in North-Western Switzerland invited 112,848 adult residents of whom 12,724 participated at baseline. Between July 2020 and December 2021, 6396 participants answered to additional 18 monthly online questionnaires. Depression symptoms were repeatedly measured by the DASS-21 scale. Group-based Trajectory Models methods were applied to identify clusters of similar depression trajectories. Trajectory clusters were characterized descriptively and with a Multinomial response model.

RESULTS

Three distinct trajectories were identified. The 'Highly affected' trajectory (13%) had a larger presence of younger and female participants with lower average income, higher levels of past depression, and living alone. A majority of individuals in the 'Unaffected' trajectory (52%) were of medium or high average income, older average age, without previous depression symptoms, and not living alone. The 'Moderately affected' trajectory (35%) had a composition intermediate between the two opposite 'extreme' trajectories.

CONCLUSIONS

This study is among few studies investigating depression trajectories up to the time when COVID-19 vaccination was readily available to the entire population. During these 18 months of the pandemic, depressive symptoms increased in a substantial percentage of participants. Economic support, high-quality health care system, and moderate containment measures did not sufficiently protect all population subgroups from adverse, potentially long-term psychological pandemic impacts.

Psychological distress and its associated factors among patients with chronic obstructive pulmonary disease in Hunan, China: a cross-sectional study

Patients with chronic obstructive pulmonary disease (COPD) experience a high risk for psychological distress. Understanding what factors contributing to this risk is vital for developing effective interventions to address COPD-related psychological distress. To examine psychological distress and its associated factors in COPD patients in China. This is a cross-sectional study. Using cluster random sampling, 351 COPD patients participated in and completed a questionnaire survey from June 2021 to January 2022. Instruments used in this research included a self-designed social-demographic questionnaire, the Kessler Psychological Distress Scale (K10), the COPD Knowledge Question, the Type D Personality Scale (DS-14), the COPD Assessment Test (CAT), and modified Medical Research Council Dyspnea Score (mMRC). Multivariate linear regressions were used in the final analysis. Among 351 COPD patients, 307 (or 87.5%) had psychological distress. Our univariate analysis indicated that psychological distress scores were significantly associated with monthly household income (F = 2.861, P < 0.05), exercise frequency (F = 4.039, P < 0.01), type D personality (t = 5.843, P < 0.01), years with COPD (r_s = 0.156, P < 0.01), frequency of acute exacerbation (r_s = 0.114, P < 0.05), mMRC score (r_s = 0.301, P < 0.01), and CAT score (r_s = 0.415, P < 0.01). Our final multivariate linear regression showed that exercise frequency (coefficient = -1.012, P < 0.01) was an independent protective factor of psychological distress in COPD patients, while type D personality (coefficient = 3.463, P < 0.001), mMRC score (coefficient = 1.034, P < 0.001) and CAT score were independent risk factors (coefficient = .288, P < 0.001). No relationship was observed between psychological distress and knowledge of COPD. Psychological distress is commonly presented among COPD patients in China. Findings from this study suggest promoting and increasing frequency of exercise will be beneficial in reducing psychological distress among COPD patients. This study also highlights the importance of assessing personality type, dyspnea, and impact of COPD on daily living for preventing and managing psychological distress due to COPD. In addition, Given the high rate of psychological distress among COPD patients, policymakers should consider making mental health resources easily available and accessible to this vulnerable population.

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

BACKGROUND

Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI).

METHODS

This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period.

RESULTS

A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (-) groups had a higher risk of MACE [95% confidence interval (CI) 1.74-6.07] (95% CI 1.25-2.96) and ISR (95% CI 3.09-8.28) (95% CI 1.85-6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (-) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients.

CONCLUSIONS

These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

Nurse-led counseling for coronary artery disease patients: A 1-year follow-up study

Nurse-led counseling and systematic follow-up have been shown to reduce cardiovascular risk factor levels. The study aims were to investigate if cardiovascular risk factor levels could be reduced in patients with coronary artery disease with a nurse-led intervention and to report patients' evaluations of nurse-led counseling. The study design was a real-life longitudinal follow-up counseling intervention. Data were collected from November 2017 to May 2020. The nurse-led intervention and patients' follow-up time was 1 year. Of the 78 patients recruited, 74 completed the study. The most significant findings were in the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides at every follow-up visit compared to their baseline levels and that waist circumference decreased during the 1-year follow-up. Patients assessed the quality of nurse-led counseling to be very good, though it decreased slightly during follow-up. The results suggest the integrated care path and specialized and primary care for coronary artery disease patients need further development. More research is needed on how to strengthen patients' self-management and what kind of counseling would best promote it.

Systematic review and meta-analysis of association of polymorphisms in inflammatory cytokine genes with coronary artery disease

BACKGROUND

It has comprehensively been acknowledged that a genetic contribution, especially in immune inflammatory players, such as interleukin (IL)-6 and tumor necrosis factor (TNF)-α, are critically involved in the pathophysiology of coronary artery disease (CAD). This meta-analysis study aimed to reach a conclusive understanding of the role of genetic polymorphisms, including IL6 gene C572G (rs1800796) and G174C (rs1800795) as well as TNFA gene G238A (rs361525) and G308A (rs1800629) in susceptibility to CAD.

METHODS

Two major databases, namely MEDLINE and Scopus, were searched to find the studies surveying the mentioned polymorphisms and CAD susceptibility up to July 2020. Association comparison between the polymorphisms and CAD susceptibility were assessed using pooled odds ratio (OR) and their corresponding 95% confidence interval (CI).

RESULTS

This meta-analysis study was conducted on 69 papers (73 population studies), comprising 5062 patients and 8446 controls for IL6 gene rs1800796 (17 studies), 13801 patients and 16215 controls for IL6 gene rs1800795 (38 studies), 1439 patients and 2850 controls for TNFA gene rs361525 (5 studies), and 5051 patients and 3958 controls for TNFA gene rs1800629 (13 studies), according to inclusion and exclusion criteria. There were statistically positive association between all genetic comparisons of IL6 gene rs1800795 polymorphism and the CAD risk. Moreover, the recessive model (CC vs. CG + GG) in IL6 gene rs1800796 polymorphism had marginally significant association with decreased risk of CAD. None of the TNFA gene polymorphisms were associated with CAD risk.

CONCLUSIONS

The meta-analysis revealed the positive association of IL6 gene rs1800795 polymorphism in susceptibility to CAD.

Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study

BACKGROUND

Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors.

AIMS

The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany.

METHODS

For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20).

RESULTS

Participation rate in the intervention phase was 67% (n=40), and participants reported high satisfaction (M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group (t(60)=3.07, p=0.003), but not in the waiting control group t(60)=-0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors (t(60)=3.88, p<0.001).

CONCLUSION

This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.

[Effects of propofol sedation on psychological stress in surgical patients under epidural]

OBJECTIVE

To explore the effects of propofol sedation on psychological stress in patients undergoing surgery under epidural anesthesia.

METHODS

Sixty patients scheduled to undergo elective ileostomy closure under epidural anesthesia were randomized into propofol sedation group and control group (n=30). The patients in the sedation group received a loading dose of propofol of 0.6 mg·kg- 1· h- 1 followed by a maintenance dose with continuous infusion of 3 mg·kg- 1· h- 1 given after the Observer's Assessment of Alertness/Sedation (OAA/S) score reached 2-3. An equivalent volume of normal saline was administered in patients in the control group. The patients' preoperative and intraoperative anxiety scores were assessed with the State Anxiety Inventory (SAI) on the day before and on the first day after the surgery, respectively. The mean blood pressure (MBP), heart rate (HR), SpO2, OAA/S, and the indicators of psychological stress of brain functional state of the patients (including the wavelet index [WLi], anxiety index [ANXi], comfortable index [CFi] and pain index [Pi]) were recorded at 5 min after entering the operating room (T0), at the time of lumbar puncture (T1) and change to supine position after the puncture (T2), at 20 s (T3), 40 s (T4), and 60 s (T5) after intravenous administration, and at 2 min (T6), 4 min (T5), 6 min (T8), 8 min (T9), 10 min (T10) and 40 min (T11) after skin incision. The patient's satisfaction with anesthesia was assessed with the Visual Analog Scale (VAS) score on the first day after the operation. Serum cortisol level was measured before anesthesia and at the end of operation to calculate the changes in cortisol level.

RESULTS

The two groups of patients were comparable for preoperative SAI scores (P>0.05); The patients in the sedation group appeared to have lower intraoprative SAI scores, but this difference was not statistically significant (P=0.05). MBP, HR, and SpO2 at the time points from T6 to T10 and OAA/S, WLi, ANXi, CFi, and Pi at the time points from T6 to T11 were significantly lower in the sedation group (all P < 0.05), and these parameters were not significantly different between the two groups at the other time points (all P>0.05). The patient satisfaction scores were significantly higher in the sedation group (Z=2.07, P < 0.05). Compared with the preoperative levels, serum cortisol level at the end of the operation was increased in the sedation group but lowered in the control group, and the variations of serum cortisol level differed significantly between the two groups (t=4.75, P < 0.01).

CONCLUSIONS

Intraoperative propofol sedation can alleviate the patients' anxiety, improve the comfort level, and lessen physiological stress during surgeries under epidural anesthesia.