Depression and cardiovascular diseases

Impact of Depression on Activation and Summer Heat Adaptation in Older Adults With Cardiovascular Concerns: Empirical Research Quantitative

AIM

To investigate the effects of depression on patient activation and summer heat adaptation, considering important contributory factors in older adults with increased cardiovascular health concerns on extremely hot days.

DESIGN

Cross-sectional study adhering to the STROBE guidelines.

METHODS

Between July and August 2020, a questionnaire survey was administered to 245 older adults at increased risk of cardiovascular diseases in rural areas. Data were collected utilising validated and reliable tools to assess patient activation, depression, summer heat adaptation, frailty, physical activity and other health-related characteristics. Hierarchical regression, mediation and path analyses were conducted to examine the association between activation, depression and summer heat adaptation, while controlling for covariates.

RESULTS

Most participants exhibited the lowest level of activation (75.1%) and a low/moderate level of summer heat adaptation (80.4%). Depression negatively affected activation (β = -0.247), while its indirect effect on patient activation through summer heat adaptation was insignificant (p > 0.05). Education (β = 0.380) and a family history of cardiovascular disease (β = 0.121) positively influenced activation, while alcohol consumption had a negative influence (β = -0.219). When integrating the influence of these three contributory factors, the associative relationship between depression and activation through summer heat adaptation demonstrated a good model fit (chi-square = 8.944, p > 0.05; comparative fit index = 0.987; root mean square error of approximation = 0.045).

CONCLUSION

Improving older adults' activation for self-managing chronic conditions in summer requires tackling depression, enhancing heat adaptation and addressing concerns related to lack of education and alcohol consumption.

PATIENT OR PUBLIC CONTRIBUTION

Patients with cardiovascular diseases were involved in piloting the questionnaire and provided examples to address older adults' concerns related to self-management and heat adaptation.

Clinical significance of NT-proBNP as a predictive biomarker of depressive symptoms in cardiac patients

Introduction

Depression is a significant comorbidity linked to poor subjective and objective health outcomes in cardiac patients. The paucity of data necessitates further research to elucidate the pathophysiological connection between depression and cardiac diseases in the presence of N-terminal pro-brain natriuretic peptide (NT-proBNP). Therefore, the current systematic review investigated the clinical significance of NT-proBNP as a predictive biomarker in cardiac patients with depressive symptoms.

Methods

Two researchers independently performed an extensive search of published literature from inception until April 2024 on PubMed, Web of Science, and Cochrane Library in accordance with the PRISMA guidelines. From a total of 452 records, 29 articles were eligible for full-text review, whereof, data from 14 articles were systematically collated. Based on the Newcastle-Ottawa Scale (NOS) criteria, all studies earned 6-9 stars and were of good quality.

Results

Among a total population of 4,035, male patients were predominantly higher (n = 2,618, 65.0%). Approximately, 31.3% (n = 1,264) cardiac patients were depressed. The mean age ranged between 56 and 76 and 58-73 years for depressed vs. non-depressed individuals respectively. More than half of the patients presented with heart failure (n = 2,234, 55.4%), followed by acute myocardial infarction (n = 1,368, 34.0%), coronary artery disease (n = 674, 16.7%), and acute coronary syndrome (n = 164, 4.1%). Poor ventricular function (26.1 ± 6.8 to 37.65 ± 12.71) and worsened NYHA class II-III functional symptoms (moderate-marked limitations) were more prevalent in depression. In addition, three studies found that age and female gender were significant risk factors in depressed patients. Significant clinical relevance was established between increased NT-proBNP and depressive symptoms in seven studies. NT-proBNP values ranged between 138 and 12,000 pg/ml vs. 108 to 6,000 pg/ml for depressed vs. non-depressed patients.

Conclusion

The presence of elevated NT-proBNP in depression demonstrated adverse cardiovascular outcomes and played a crucial role in predicting the clinical prognosis. Future NT-proBNP studies with predefined follow-up period at different time intervals, and in clinically depressed patients are highly recommended.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42024536115).

Disproportionately raised risk of adverse outcomes in patients with COPD and comorbid type 2 diabetes or depression: Swedish register-based cohort study

BACKGROUND

We aimed to examine if patients with COPD and comorbid type 2 diabetes, or COPD with comorbid depression or anxiety, had disproportionally raised excess risks of subsequent cardiovascular disease and mortality.

METHODS

This general population-based cohort study used data from Swedish national registers, with follow-up during 2005-2018. Cox regression estimated risks of cardiovascular disease or mortality, producing hazard ratios (HR) with (95% confidence intervals). Interaction testing quantified disproportionally increased excess risks.

RESULTS

Among 5,624,306 individuals, 332,549 had a COPD diagnosis. Compared with individuals who did not have COPD or type 2 diabetes, all-cause mortality risk was higher for individuals who had either COPD or type 2 diabetes, with HR 2.68 (2.66-2.69) and 1.70 (1.69-1.71), respectively. Having both conditions produced an HR of 3.72 (3.68-3.76). Among cardiovascular outcomes, the highest risks were found for chronic heart failure: COPD only, HR 2.87 (2.84-2.90); type 2 diabetes only, 1.86 (1.84-1.88); and both, 4.55 (4.46-4.64). Having both COPD and type 2 diabetes was associated with disproportionally higher excess risks than expected from the sum of the individual diseases, except for cerebrovascular disease or ischemic heart disease. For COPD and depression/anxiety, all-cause mortality risk was associated with COPD only, HR 2.74 (2.72-2.76); depression/anxiety only, 2.39 (2.38-2.40); and both 4.72 (4.68-4.75). Chronic heart failure was associated with COPD only, HR 2.74 (2.71-2.78); depression/anxiety only, 1.31 (1.30-1.32); and both, 3.45 (3.40-3.50). This disease combination was associated with disproportionally higher excess risks than expected, except for atrial fibrillation.

CONCLUSIONS

Type 2 diabetes or depression/anxiety in COPD patients were associated with disproportionally excess risks for cardiovascular disease and mortality. It is important for clinicians to be aware of these greater than expected risks, to prevent further cardiovascular morbidity and mortality.

Association between life's crucial 9 and severe abdominal aortic calcification in U.S. Adults: the mediating role of the systemic inflammatory response index

Background

Life's Crucial 9 (LC9) is an emerging cardiovascular health scoring system that incorporates Life's Essential 8 (LE8) alongside mental health factors. However, its relationship with severe abdominal aortic calcification (SAAC) remains poorly understood.

Objectives

The objective of this study is to investigate the relationship between LC9 scores and the incidence of SAAC in the US population.

Methods

Data from 2,323 participants were analyzed, originating from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycle. In exploring the dynamics of LC9, its constituents, and their relationship with SAAC, we employed advanced statistical methodologies, specifically multivariable logistic regression and weighted quantile sum regression. Subgroup interaction analyses were conducted to reinforce the conclusions, and mediation analysis was employed to investigate how the systemic inflammatory response index (SIRI) influences the connection between LC9 and SAAC.

Results

In fully adjusted models, an increase of 10 points in LC9 scores was associated with a 26% reduction in the prevalence of SAAC, achieving statistical significance (P < 0.001). As LC9 scores increased, a significant decline in SAAC prevalence was noted (P < 0.05). The WQS analysis pinpointed strong links between the occurrence of SAAC and variables including exposure to tobacco, blood pressure levels, blood glucose concentrations, and mental health status, the odds ratio stood at 0.244, with the 95% CI extending from 0.119 to 0.495. SIRI was positively correlated with SAAC (P < 0.05) and decreased with rising LC9 scores (β = -0.09, P < 0.001). Mediation analysis revealed that the SIRI significantly influenced the linkage between LC9 and SAAC, accounting for 5.8% of the mediation effect, with a statistically significant p-value (P < 0.001).

Conclusion

This research highlights a robust inverse relationship between elevated LC9 scores and reduced SAAC incidence, suggesting the significant role of LC9 as a key factor in diminishing the frequency of SAAC. Furthermore, SIRI mediates this relationship.

Depression, reduced physical activity and the risk of heart disease: a prospective cohort of European middle-aged and older adults

OBJECTIVE

To assess the impact of depression and physical activity (PA) of different intensities on the incidence of heart disease.

METHODS

A prospective cohort study with 20 645 European middle-aged and older adults (mean baseline age 63 years; 55.1% women; median follow-up 9.5 years) was conducted using data from the Survey of Health, Ageing and Retirement in Europe. The EURO-D 12-item scale assessed depression. Moderate-intensity and vigorous-intensity PA and heart disease diagnoses were self-reported. We classified participants into the following four groups: (1) depression plus low PA, (2) no depression plus low PA, (3) depression plus moderate/high PA, (4) no depression plus moderate/high PA. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models adjusted for confounders.

RESULTS

Compared with having depression and low PA levels, adjusted HR for heart disease similarly decreased for participants with depression and moderate/high PA (moderate-intensity PA: HR=0.63, 95% CI=0.50, 0.78; vigorous-intensity PA: HR=0.69, 95% CI=0.53, 0.89) and participants without depression and low PA (moderate-intensity PA: HR=0.64, 95% CI=0.50, 0.82; vigorous-intensity PA: HR=0.68, 95% CI=0.58, 0.80). The greatest risk reduction was found in participants without depression and moderate/high PA (moderate-intensity PA: HR=0.46, 95% CI=0.37, 0.55; vigorous-intensity PA: HR=0.48, 95% CI=0.40, 0.58).

CONCLUSION

Moderate-intensity and vigorous-intensity PA seems to counteract the increased risk for heart disease associated with depression. This highlights the importance of PA as a possible intervention strategy aiming to manage the risk of heart disease among people with depression.

Comparing the Association Between Depressive Symptoms and Cardiovascular Disease Among the Middle-Aged and Elderly Population: A National Survey of 9,049 Subjects Based on the Indonesian Family Life Survey-5

Introduction

The association between depressive symptoms and cardiovascular disease (CVD) is widely acknowledged. However, there is a lack of relevant evidence among the middle-aged population in developing countries where depressive symptoms often go undetected and untreated. The objectives of this study were to assess the association between depressive symptoms and CVD in Indonesia and to compare the association between the middle-aged and elderly population.

Methods

This national cross-sectional population-based survey used secondary data from the publicly available Indonesian Family Life Survey (IFLS-5). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies Depression (CESD-R-10) scale, and data on CVD and sociodemographic variables were self-reported. Binary logistic regression was performed to determine the association between depressive symptom and self-reported CVD after adjusting for confounding factors, with an adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Subgroup analysis was performed based on the age group.

Results

The study included 9049 respondents, predominantly the middle-aged (71.1%), female (52.6%), elementary school graduates (50.7%), non-smokers (59.0%), non-obese (77.3%), without depressive symptoms (82.2%), and without self-reported CVD (96.7%). Respondents with depressive symptoms were more likely to experience self-reported CVD (AOR = 1.56; 95% CI = 1.18-2.05; p-value = 0.002), after adjusting for potential confounders. A significant association was observed between depressive symptoms and self-reported CVD in elderly respondents (AOR = 1.89; 95% CI = 1.22-2.94; p-value = 0.005), whereas no significant association was observed in the middle-aged group (AOR = 1.39; 95% CI = 0.98-1.98; p-value = 0.063) after adjusting for confounders.

Conclusion

Respondents with depressive symptoms were associated with an increased risk of self-reported CVD, highlighting the urgent need for targeted prevention strategies, especially for those struggling with depressive symptoms.

Analysis of risk factors for depression in peritoneal dialysis patients and establishment of a risk nomogram model

OBJECTIVE

This study aims to analyze the risk factors for depression in peritoneal dialysis patients and to develop a predictive nomogram model for assessing these risks.

METHODS

A total of 326 peritoneal dialysis patients treated between August 2021 and December 2023 were selected as the training set. These patients were categorized into a non-depression group (229 cases) and a depression group (97 cases) based on the presence of depression. Additionally, 104 peritoneal dialysis patients from the same period were selected as the validation set. Clinical data were collected from all patients for analysis.

RESULTS

The depression group had higher proportions of female patients, non-employed individuals, those with a per capita monthly income of <2000-yuan, cardiovascular complications, cerebrovascular complications, and sleep disorders compared to the non-depression group. Additionally, the levels of hemoglobin and blood uric acid were lower in the depression group than in the non-depression group (p < 0.05). Gender, work status, per capita monthly income, cardiovascular complications, cerebrovascular complications, and sleep disorders are risk factors for depression in peritoneal dialysis patients (p < 0.05), while hemoglobin and blood uric acid are protective factors for depression in peritoneal dialysis patients (p < 0.05). Calibration curve analysis results showed that the predicted probability was basically consistent with the actual incidence rate. The results of the Decision Curve Analysis (DCA) demonstrated that the nomogram model developed in this study has strong clinical applicability.

CONCLUSION

The nomogram model for predicting depression in peritoneal dialysis patients, which incorporates factors such as gender, work status, per capita monthly income, cardiovascular complications, cerebrovascular complications, sleep disorders, hemoglobin levels, and blood uric acid levels, demonstrates excellent calibration and discrimination. Additionally, it has high clinical applicability.

MicroRNA signatures in neuroplasticity, neuroinflammation and neurotransmission in association with depression

Depression is a multifactorial disorder that occurs mainly on account of the dysregulation of neuroplasticity, neurotransmission and neuroinflammation in the brain. In addition to environmental /lifestyle factors, the pathogenesis of disease has been associated with genetic and epigenetic factors that affect the reprogramming of normal brain function. MicroRNA (miRNAs), a type of non-coding RNAs, are emerging as significant players that play a vital role in the regulation of gene expression and have been extensively explored in neurodegenerative disorders. Recent studies have also shown the role of gut microbiota that forms a complex bidirectional network with gut brain axis, impacting neuroinflammation in case of Parkinson's disease and depression. Translating targeted miRNA-based therapies for the treatment of neurological disorders including depression, into clinical practice remains challenging due to the ineffective delivery of the therapeutic molecules and off-target effects of the specific miRNAs. This review provides significant insights into how miRNAs are emerging as vital players in the development of depression, especially the ones involved in three important processes including neuroplasticity, neurotransmission and neuroinflammation. In this review, the current status of miRNAs as biomarkers for therapeutic interventions in the case of depression has been discussed along with an overview of future perspectives, like use of nanotechnology and gene editing, keeping in view other multifactorial disorders where such interventions by mimics and inhibitors have already reached clinical trials. The challenges for targeting the specific miRNAs for therapeutic outcomes have also been highlighted.

Relationship Between Sleep Time and Depressive Symptoms in Middle-Aged and Elderly Chinese: Mediating Role of Body Pain

Objective

Existing research has yet to adequately examine the correlation between sleep time, body pain, and depressive symptoms. This study seeks to elucidate the interconnections between these three elements.

Methods

The study used 2020 CHARLS data for analysis. To assess the intricate association among sleep time, body pain, and depressive symptoms, the study employed Spearman correlation analysis, multiple logistic regression, restricted cubic splines, and mediation effect analysis based on bootstrap testing.

Results

Risk factors for depressive symptoms in middle-aged and elderly Chinese include physical pain and reduced sleep duration. Results from the RCS suggest that the lowest risk of depressive symptoms occurs when the sleep time for the middle-aged and elderly population is approximately 7.5 hours. Body pain accounts for a 19.05% mediating effect between sleep time and depressive symptoms, and even after controlling confounding factors, there remains a 7.5% mediating effect.

Conclusion

The research findings indicate that there is a significant correlation among sleep time, body pain, and depressive symptoms. Insufficient sleep time and body pain can lead to depressive symptoms. Body pain plays a partial mediating role between sleep time and depressive symptoms.

Psychological barriers to adherence to pharmacological treatment of cardiovascular risk conditions in healthcare workers

Introduction

Cardiovascular diseases (CVD) are the leading cause of death globally. This burden of disease is particularly high among healthcare workers (HCW). However, adherence to treatment of well-known cardiovascular risk conditions (CRC) still represents a challenge, even among healthcare workers (HCW). Since the identification of modifiable related factors is a prerequisite for developing effective public health interventions, the purpose of this study was to develop a predictive model for adherence to pharmacological treatment (APT) for CRC in HCW, using psychological variables related to CVD mortality, such as the type A behavior pattern, perceived stress, depression, anxiety and attitudes toward treatment adherence.

Methods

An anonymous online survey was completed by a non-probabilistic sample of 1,377 Mexican HCW from tertiary public hospitals, with a diagnosis of only one of the following CRC: ischemic heart disease, diabetes, high blood pressure or dyslipidemia. Sociodemographic questionnaires and self-reported measures were used to collect data: PSS-14 for perceived stress, Type A Behavior Pattern Withdrawal Scale, HADS for anxiety and depression symptoms, the Attitudes toward Medication Scale and the Therapeutics Adherence Scale for Patients with Chronic Diseases.

Results

Anxiety and depression symptoms were higher in the group with risk for non-adherence, while perceived stress and positive attitudes toward medication were higher in the group with likelihood of adherence (p ≤ 0.05). The Type A behavior pattern and sociodemographic variables did not differ between groups. In a regression model, positive attitudes toward medication and perceived stress doubled APT (OR = 2.04, CI95% = 1.39-2.97; OR = 2.02, CI95% = 1.71-2,39, respectively) whereas depression decreased its likelihood (OR = 0.61, CI95% = 0.58-0.73).

Discussion

In conclusion, psychoeducation for patients with CRC should include information on the advantages of medication for treating their condition, even if they are HCW. Promoting adaptative coping skills to handle daily stressful events, including their CRC, could reduce the level of stress that could increase their APT but also their cardiovascular risk. Moreover, our data provide evidence regarding the importance of identifying and treating depressive symptoms as part of the standard care of this population.

Moderating Effect of Muscular Strength in the Association between Cardiovascular Events and Depressive Symptoms in Middle-Aged and Older Adults-A Cross Sectional Study

BACKGROUND

Depression and cardiovascular diseases are two main health conditions contributing to the global disease burden. Several studies indicate a reciprocal association between them. It is still unclear how changes in overall muscle strength may impact this association. This study aimed to analyse how muscular strength moderates the relationship between cardiovascular events and depressive symptoms among middle-aged and older adults.

METHODS

Wave 8 of the population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) cross-sectional data, which included 41,666 participants (17,986 men) with a mean age of 70.65 (9.1) years old, was examined. Grip strength was measured twice on each hand using a dynamometer. The 12-item EURO-D scale was employed to gauge depressive symptoms.

RESULTS

Grip strength negatively moderates the link between cardiovascular events and depressive symptoms (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.06, -0.05). Additionally, the grip strength moderation values in the significant zone for males and females were less than 63.2 kg and 48.3 kg, respectively.

CONCLUSIONS

Muscular strength modifies depressive symptoms and lessens their correlation with cardiovascular diseases. Muscle-strengthening activities could be incorporated into primary and secondary preventive strategies to reduce the burden of depression in people with CVD.

Psychotherapeutic drug-induced life-threatening arrhythmias: A retrospective analysis using the Japanese adverse drug event report database

Background

Drug-induced life-threatening ventricular arrhythmias including torsade de pointes (TdP), ventricular tachycardia (VT), and ventricular fibrillation (VF) are serious cardiac side effects. Psychotherapeutic drugs are known to be risk factors for arrhythmias. The aim of this study was to evaluate psychotherapeutic drugs associated with life-threatening ventricular arrhythmias using the Japanese Adverse Drug Event Report (JADER) database.

Methods

From the JADER database (April 2004 to September 2022), cases of TdP, VT, VF, and QT prolongation in patients taking psychotherapeutic drugs as 'suspected drugs' were extracted. The adjusted reported odds ratio (aROR) was calculated to identify potential drugs involved in combined TdP/VF/VT or combined QT prolongation/TdP.

Results

Of the 4,530,772 cases reported, life-threatening arrhythmia-related adverse events were reported in 1760 cases (QT prolongation 1261, TdP 192, VF 108, VT 199) among 909 patients; 58.9% of patients were female, and the highest incidence was among patients aged 80-89 years (18.6%), followed by patients aged 70-79 years (15.4%). The highest aROR for TdP/VF/VT was found for trazodone (17.1), followed by sulpiride (10.8), haloperidol (9.8), donepezil (9.1), and fluvoxamine (7.9). The highest aROR for QT prolongation/TdP was found for guanfacine (87.8), followed by sultopride (60.1), escitalopram (21.0), trazodone (12.8), and donepezil (9.3).

Conclusions

This study showed that typical antipsychotics, antidepressants, and antidementia drugs were associated with life-threatening arrhythmia-related adverse events in a Japanese clinical setting. These events were more frequent in women and elderly individuals.

Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link

OBJECTIVE

To explore the reciprocal relationship of depression and atrial fibrillation (AF).

METHODS

A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies.

RESULTS

There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20-40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation.

CONCLUSIONS

A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients' course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients' depressive symptoms. KEY POINTSAF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxietyA reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggestedAF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depressionAlso, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versaPersistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burdenDepression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablationThus, strategies which can reduce anxiety and depression may improve AF patients' course and treatment outcomesAlso, effective antiarrhythmic therapies to control AF may alleviate patients' depressive mood.