Depressive mood is independently related to stroke and cardiovascular events in a community

Association of Maternal Glucose Concentrations During Pregnancy With Cardiovascular Alterations in Early Childhood: A Prospective Birth Cohort Study

BACKGROUND

Maternal hyperglycemia has been associated with cardiovascular disease risks in offspring. Previous studies were mostly conducted to test this association in pregnancies with (pre)gestational diabetes mellitus. However, the association may not be limited to populations with diabetes only.

OBJECTIVES

The aim of this study was to assess the association between gestational glucose concentrations in women without (pre)gestational diabetes mellitus and childhood cardiovascular alterations at the age of 4 y.

METHODS

Our study was based on the Shanghai Birth Cohort. Briefly, among 1016 nondiabetic mothers (age: 30.8 ± 3.42 y; BMI: 21.3 ± 2.94) and their offsprings (age: 4.41 ± 0.22 y; BMI: 15.0 ± 1.56; 53.0% males), results of maternal 1-h oral OGTT between 24 and 28 gestational weeks were obtained. Childhood blood pressure (BP) measurement, echocardiography, and vascular ultrasound were performed at 4 y old. Linear regression and binary logistic regression were conducted to test the association between maternal glucose and childhood cardiovascular outcomes.

RESULTS

Compared with children from mothers with glucose concentrations in the lowest quartile, children from mothers in the highest quartile had higher BP (systolic: 97.0 ± 7.41 compared with 98.9 ± 7.82 mmHg, P = 0.006; diastolic: 56.8 ± 5.83 compared with 57.9 ± 6.03 mmHg, P = 0.051) and lower left ventricular ejection fraction (92.5 ± 9.15 compared with 90.8 ± 9.16 %, P = 0.046). Also, higher maternal OGTT 1-h glucose concentrations across the full range were associated with higher childhood BP (systolic: β: 0.56; 95% CI: 0.19, 0.93; diastolic: β: 0.36; 95% CI: 0.05, 0.66). Logistic regression showed, compared with children from mothers in the lowest quartile, children from mothers in the highest quartile had a 58% (OR=1.58; 95% CI: 1.01, 2.47) higher odds of elevated systolic BP (≥90th percentile).

CONCLUSIONS

In a population without (pre)gestational diabetes mellitus, higher maternal OGTT 1-h glucose were associated with childhood cardiovascular structure and function alterations. Further studies are needed to assess whether interventions to reduce gestational glucose will mitigate subsequent cardiometabolic risks in offspring.

Gender differences in the association between depressive symptoms and carotid atherosclerosis among middle-aged and older Koreans: the Namwon study

We investigated the association of depressive symptoms with carotid intima-media thickness (IMT) and plaques in the general Korean population. A total of 7,554 Korean males and females aged 45-74 yr who were free from cardiovascular diseases were included in the analyses. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Subjects with a score of ≥16 were classified as having clinically significant depressive symptoms. Carotid ultrasonography was used to measure mean carotid IMT (C-IMT) and to determine the presence of plaques. A significant association between depressive symptoms and C-IMT was observed only in females. After adjustment for established cardiovascular risk factors, females with depressive symptoms had significantly greater C-IMT than females without depressive symptoms (mean difference 0.011±0.004 mm; 95% confidence interval, 0.003-0.019 mm). Compared with controls, the fully adjusted risk of females with depressive symptoms for abnormal C-IMT (≥1.0 mm) was significant (odds ratio, 1.63; 95% confidence interval, 1.16-2.30). No significant association between depressive symptoms and carotid plaques was observed in either gender. This study shows a significant association between depressive symptoms and C-IMT in middle-aged and older females.

Predictors for increasing eligibility level among home help service users in the Japanese long-term care insurance system

Objectives. This cross-sectional study described the prevalence of possible risk factors for increasing eligibility level of long-term care insurance in home help service users who were certified as support level 1-2 or care level 1-2 in Japan. Methods. Data were collected from October 2011 to November 2011. Variables included eligibility level, grip strength, calf circumference (CC), functional limitations, body mass index, memory impairment, depression, social support, and nutrition status. Results. A total of 417 subjects (109 males and 308 females, mean age 83 years) were examined. There were 109 subjects with memory impairment. When divided by cut-off values, care level 2 was found to have higher prevalence of low grip strength, low CC, and depression. Conclusions. Some potentially modifiable factors such as muscle strength could be the risk factors for increasing eligibility level.

Field medicine: a new paradigm of geriatric medicine

It is only during the last half century that aging came to be truly thought of as a societal issue rather than simply a personal one, as well as a challenge to be tackled by science and medicine. Diseases used to be studied only in hospitals and laboratories, centering on patients treated there. However, caring for elderly people in hospitals provides only a small glimpse into their world. With an advancing aged population, the reality of old age and age-related chronic illnesses takes place in homes and communities. To truly understand the health issues of the elderly, we ventured into communities and visited elderly persons in their homes and cultural environments in Kochi prefecture. The Department of Geriatric Medicine, Kochi Medical School, was the first in Japan to incorporate the Comprehensive Geriatric Assessment in preventive intervention and evaluation of the medical problems of elderly people in field settings, which could not be completely resolved in the hospital. Geriatric findings in field settings in Kochi before (1990-2000) and after (2000-2010) the introduction of the nationwide long-term care insurance system throughout Japan were reviewed. Field medicine also enables us to explore the aging of people living not only in Japan but also in several Asian communities and, further, into those living in atypical environments such as the Himalayan highlands. Based on the geriatric findings of field medicine carried out in sites with different ecology and cultures, we reconsidered the optimal aging situation based on the activities of daily living and quality of life, as well as chronic diseases of elderly people throughout the world. In this review article, we would like to highlight the importance of field medicine as a new paradigm of geriatric medical research.

Depression in vascular pathologies: the neurologist's point of view

The coexistence of depression and cardiovascular disease (CVD) is regularly discussed, and much debated. There is strong evidence that there are pathophysiological mechanisms, particularly endothelial dysfunction, altered platelet aggregation, and hyperactivation of the thrombosis cascade, which coexist with hypothalamic-pituitary-adrenocortical axis dysfunction, and link depression to CVD. Therefore, depression should not be automatically considered to be a consequence of life impairment due to myocardial infarction or major stroke. Probably, it should be considered as one of the many other stressful events, or “genetic reactions to life”, which are risk factors for CVD development. This review will examine the significance of depression in clinical daily practice, its pathophysiology as a determinant in vascular events, and its real importance in, before, and after many CVD events.

Effects of dipping and psychological traits on morning surge in blood pressure in healthy people

Despite the role of anxiety, depression and hostility in the pathogenesis of cardiovascular diseases, their impact on two significant cardiovascular risk factors, nocturnal dipping and morning surge in blood pressure (MSBP), are largely ignored and primarily studied in clinical populations. This study examined the effects of dipping and psychological traits on MSBP in healthy people. Nocturnal dipping and MSBP were derived from 24-h ambulatory BP obtained in 77 men and 79 women, mean age 32.8 (s.d.: 7.4). Differences in depression, anxiety and hostility were examined by questionnaires. Higher levels of dipping (P<0.0001) and depressive symptoms (P=0.01) independently contributed to increased MSBP. Dipping interacts with depression (P=0.04), hostility (P=0.01) and anxiety (P=0.04) in determining MSBP. Low dippers with higher scores on the psychological traits showed higher MSBP than high dippers. A significant MSBP interaction was found between sex and depressive symptoms (P=0.05), anxiety (P<0.0001) and hostility (P=0.01) with higher scores associated with increased MSBP observed in males. Findings underscore depression as a predictor of MSBP independent of dipping. The clinically significant relationship between dipping and non-dipping patters, psychological traits and MSBP requires further investigation.

Optimizing outcomes for patients with depression and chronic medical illnesses

Depression and comorbid chronic medical conditions such as coronary heart disease, diabetes mellitus, and osteoarthritis are frequently seen in the primary care setting, and the interaction of these illnesses can complicate diagnostic and treatment efforts. Although the etiologies of these bidirectional associations are not well understood, a number of negative outcomes are apparent, and challenges exist at patient, provider, and healthcare system levels to better recognize and treat depression in patients with chronic medical comorbidity. Such patients are more likely to present with somatic complaints, engage in unhealthy behaviors, harbor unhealthy thoughts or cognitions, and are less likely to comply with therapeutic recommendations. Primary care encounters often represent the only opportunities for these patients to address these issues and obtain the professional attention their depression requires. For clinicians, forging empathetic partnerships with patients, prescribing appropriate treatments, and closely monitoring symptoms and therapeutic progress are invaluable for optimal management of both affective and medical disorders. Further opportunities to improve care also exist at the healthcare system level, such as developing, funding, and implementing multimodal collaborative care models in the primary care setting.

Stress, geomagnetic disturbance, infradian and circadian sampling for circulating corticosterone and models of human depression?

While certain circadian hormonal changes are prominent, their predictable assessment requires a standardization of conditions of sampling. The 24-hour rhythm in circulating corticosterone of rodents, known since the 1950s, was studied as a presumed proxy for stress on 108 rats divided into 9 groups of 6 male and 9 groups of 6 female animals sampled every 4 hours for 24 hours. In a first stress study, the "no-rhythm" (zero-amplitude) assumption failed to be rejected at the 5% probability level in the two control groups and in 16 out of the 18 groups considered. A circadian rhythm could be detected with statistical significance, however, in three separate follow-up studies in the same laboratory, each on 168 rats kept on two antiphasic lighting regimens, with 4-hourly sampling for 7 or 14 days. In the first stress study, pooling of certain groups helped the detection and assessment of the circadian corticosterone rhythm. Without extrapolating to hormones other than corticosterone, which may shift more slowly or adjust differently and in response to different synchronizers, the three follow-up studies yielded uncertainty measures (95% confidence intervals) for the point estimate of its circadian period, of possible use in any future study as a reference standard. The happenstance of a magnetic disturbance at the start of two follow-up studies was associated with the detection of a circasemiseptan component, raising the question whether a geomagnetic disturbance could be considered as a "load". Far beyond the limitations of sample size, the methodological requirements for standardization in the experimental laboratory concerning designs of studies are considered in the context of models of depression. Lessons from nature's unforeseen geomagnetic contribution and from human studies are noted, all to support the advocacy, in the study of loads, of sampling schedules covering more than 24 hours.