Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association

Prospective association between depressive symptoms and incident hypertension: Results from the Hispanic community health study/study of Latinos

OBJECTIVE

Previous research on depressive symptoms with incident hypertension has yielded mixed results, and this relationship has not been studied in a diverse group of Hispanic/Latino adults.

METHODS

We studied 5927 Hispanic/Latino adults aged 18-74 years from four U.S. cities who attended baseline (2008-2011) and follow-up (2014-2017) examinations of the Hispanic Community Health Study/Study of Latinos. Baseline depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10; clinically relevant depressive symptoms were defined as ≥10 points. Blood pressure (BP) was measured using a standardized protocol at both examinations. Hypertension was defined as measured systolic BP ≥130 mmHg, or diastolic BP ≥80 mmHg, or self-reported antihypertension medication use. Analyses accounted for the complex survey design.

RESULTS

Among 5927 persons without hypertension at baseline, the six-year age-adjusted incidence rates of hypertension were 40 and 31 per 1000 person-years among those with and without elevated depressive symptoms, respectively. Persons with elevated depressive symptoms had a 25 % (p = .003) higher 6-year incidence of hypertension than those with fewer symptoms, after adjusting for sociodemographic and clinical covariates. There was an interaction between depressive symptoms and age (pinteraction < 0.05). Among adults aged 18-34 years without hypertension at baseline (n = 1748), those with elevated depressive symptoms had 80 % higher 6-year incidence of hypertension than those with fewer symptoms (p = .001).

CONCLUSIONS

These findings suggest that depressive symptoms are a risk factor for hypertension in young Hispanic/Latino adults. Early screening and treatment of depressive symptoms may aid in the prevention of hypertension.

Beyond the heart: The role of psychological factors and coping strategies in cardiovascular rehabilitation

BACKGROUND

Cardiovascular disease (CVD) is associated with several risk and protective factors, including psychological variables, such as anxiety and depressive symptoms, stress and coping strategies. These factors may be either a cause or a consequence of CVD and are thought to influence the cardiac rehabilitation (CR) process after acute cardiac event, a multifaceted intervention that is crucial for reducing rehospitalisation and mortality. The main aim of this study was to correlate such psychological components with cardiac outcomes in a sample of 315 CVD referred to an in-hospital CR program.

METHODS

Participants completed self-report questionnaires on perceived stress, anxiety and depressive symptoms, and coping styles.

RESULTS

Females (36.51 %) reported higher levels of depressive symptoms and turning to religion as a coping strategy compared to male. Perceived stress did not differ between male and female, but it was found to be significantly higher in heart failure patients, regardless of gender. Functional outcomes after a CR program were not predicted by any psychological variable, whereas clinical outcomes were predicted by depressive symptoms and coping strategies (social support and positive attitude). Finally, perceived health status was predicted by anxiety, depressive symptoms and avoidance.

CONCLUSIONS

These findings confirm the importance of conducting psychological screening in patients with CVD, as recommended by international guidelines, and highlight the need to provide them with adequate psychological support to reduce the adverse consequences of cardiac disease, and to promote protective attitudes and behaviours through tailored psychological interventions to improve outcomes after a CR program.

The differential impact of Type D personality on the prognosis of patients with stable coronary artery disease

OBJECTIVE

This study investigated the association between Type D personality and prognoses in stable coronary artery disease (CAD) patients by mode of endpoints, age, and methodological debates to explain substantial heterogeneity among Type D studies.

DESIGN

The prospective study was designed to recruit 590 stable CAD patients in Taiwan. Main outcome measures: Demographic and clinical characteristics, and the 14-item Type D scale-Taiwanese version were recorded at discharge.

RESULTS

Hierarchical logistic regression analyses showed, regardless of the methodological debates, Type D personality was significantly associated with MACEs though not non-cardiac outcomes in stable CAD patients after adjusting for possible confounders. Furthermore, Type D personality was especially associated with MACEs in stable CAD patients with younger age (<65 y), rather than older age (≥65 y). Subgroup analysis also showed the adverse effect of Type D personality on MACEs was larger among males, those living in the rural region, those with PTCA or stent, those with heart failure, hypertension, diabetes, and those who were smokers.

CONCLUSIONS

Regardless of whether the methodological debate is dichotomous or continuous, Type D personality was significantly associated with MACEs in stable CAD patients, some of whom had younger age, were males, smokers, or had comorbidities.

Natriuretic peptide testing in veterans hospitalized with heart failure: Potential differences by sex

BACKGROUND

Natriuretic peptide testing (NPT) is recommended to assist in diagnosis and prognostication during heart failure hospitalization (HFH). NPT on admission for HFH and sex-based variation in NPT are unknown.

OBJECTIVES

We investigated the utilization of NPT among Veterans with HFH, evaluated for sex-based differences, and examined associations with demographic, clinical, and facility characteristics.

METHODS

Among Veterans with HFH in the Veterans Affairs Healthcare System between October 2015-September 2020, we assessed the rate of NPT on admission and sex-based differences in NPT. We determined associations with demographic, clinical covariates, (comorbidities, laboratory values, loop diuretic use), and facility characteristics using logistic regression.

RESULTS

Of 55,935 patients with HFH (women=1237 (2.2 %)), women were younger (68.3 versus 72.8 years, p < 0.001), less likely to have cardiac comorbidities, and more likely to have ejection fraction >40 %. Admission NPT occurred in 78.3 % of patients (men=78.4 %, women=74.7 %; p = 0.002). In adjusted analyses for clinical and facility-related factors, women were 15 % less likely to receive NPT compared with men [odds ratio =0.85, 95 % CI (0.75, 0.98)]. In sex-stratified models, atrial fibrillation and prior loop diuretic use were associated with increased likelihood of NPT and previous NPT was associated with decreased likelihood in both sexes. Overall associations were similar in both sexes.

CONCLUSIONS

Women were less likely to receive NPT during HFH compared to men, potentially risking greater delays in HF diagnosis and treatment. Further investigation should examine the impact of the absence of admission NPT on clinical outcomes and identify strategies to improve obtaining NPT in all patients.

'Nobody wants to talk about that stuff': a qualitative investigation of the anticipated public perceptions of individuals with Inflammatory Bowel Disease

OBJECTIVE

Little research has explored in-depth qualitative opinions on anticipated public views of Inflammatory Bowel Disease (IBD) among those with the condition, and the potential impact of these views on wellbeing. This study explored the perceptions and reactions anticipated by those with IBD from the public (RQ1), and the impact these anticipated perceptions have on participants' physical and psychological health, and their quality of life (RQ2).

METHOD

Twenty participants (aged 18-56 years) were recruited via Crohn's and Colitis Australia and online IBD support forums. Individual, semi-structured interviews were conducted with participants. To avoid researcher bias, two independent data coders conducted thematic analysis to identify themes and subthemes.

RESULTS

The themes identified by both coders were further examined and reported. Four themes were identified: (1) poor public awareness of IBD; (2) difficulties with disclosure; (3) emotional and social public reactions; and lastly, (4) 'self-exclusion'. Most participants indicated that their physical health and quality of life are not impacted by their anticipated views, however, some participants reported that their psychological health is impacted.

CONCLUSION

This study uncovered the adverse impact of anticipated public views on psychological health. Regarding study implications, self-excluding behaviours should be routinely assessed in clinical practice.

Preoperative psychological distress is associated with mortality within 1 year of non-cardiac surgery

OBJECTIVE

To characterize the association between preoperative psychological distress and postoperative complications at 30 days and mortality at 1 year in a non-cardiac surgery sample.

METHOD

Data were taken from a subsample of the VISION cohort study (n = 997; 2011-2012). Participants were scheduled to undergo major non-cardiac surgery under general or regional anesthesia. Participants self-reported past 30-day psychological distress on the day of surgery using the Kessler-6 (K6) Scale. Complications were assessed via interviews and/or chart reviews. Multivariable logistic regressions characterized the relationship between preoperative psychological distress and postoperative complications. Models were fitted for sociodemographics, surgery type, preoperative medical morbidity, and smoking.

RESULTS

Among participants with a completed K6 (n = 938), 7.9 % experienced mortality within 1 year. After controlling for age, ethnicity, sex, surgery type, preoperative medical morbidity, and smoking, higher levels of preoperative psychological distress were associated with 30 day complications such as myocardial infarction, non-fatal cardiac arrest, leg/arm deep vein thrombosis/ pulmonary embolism, new acute renal failure, pneumonia, and congestive heart failure (AOR3 (3rd model), 1.12, [95 % CI, 1.02-1.22, p < 0.05]) and 1-year mortality (AOR3, 1.09, [95 % CI, 1.02-1.18, p < 0.05]). Sensitivity analyses demonstrate that the latter association was being driven by symptoms of depression (AOR3, 1.17 [95 % CI 1.04-1.33, p < 0.05]) but not anxiety (AOR2, 0.94 [95 % CI, 0.61-1.62, p > 0.05]).

CONCLUSION

Elevated preoperative distress increased the risk of 30-day complications and mortality at 1 year. These results underscore the need for future research to examine if supporting patients' mental health during the perioperative period can mitigate risk.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, no. NCT00512109 (main VISION study).

The Association of Elevated Depression Levels and Life's Essential 8 on Cardiovascular Health With Predicted Machine Learning Models and Interpretations: Evidence From NHANES 2007-2018

Background and Objective: The association between depression severity and cardiovascular health (CVH) represented by Life's Essential 8 (LE8) was analyzed, with a novel focus on ranked levels and different ages. Machine learning (ML) algorithms were also selected aimed at providing predictions to suggest practical recommendations for public awareness and clinical treatment. Methods: We included 21,279 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted ordinal logistic regression (LR) was utilized with further sensitivity and dose-response analysis, and ML algorithms were analyzed with SHapley Additive exPlanations (SHAP) applied to make interpretable results and visualization. Results: Our studies demonstrated an inverse relationship between LE8 and elevated depressive levels, with robustness confirmed through subgroup and interaction analysis. Age-specific findings revealed middle-aged and older adults (aged 40-60 and over 60) which showed higher depresion severity, highlighting the need for greater awareness and targeted interventions. Eight ML algorithms were selected to provide predictive results, and further SHAP would become ideal supplement to increase model interpretability. Conclusions: Our studies demonstrated a negative association between LE8 and elevated depressive levels and provided a suite of ML predictive models, which would generate recommendations toward clinical implications and subjective interventions.

The Role of Neuroinflammation in the Comorbidity of Psychiatric Disorders and Internal Diseases

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and autonomic nervous system (ANS) imbalance. This review synthesizes current evidence on the role of neuroinflammation in comorbid conditions such as depression, anxiety, cardiovascular disease, and diabetes mellitus, emphasizing bidirectional relationships and shared inflammatory pathways. This analysis identifies gaps in longitudinal studies, biomarker validation, and the integration of multidisciplinary care models. Emerging therapeutic approaches, including IL-6 inhibitors, vagus nerve stimulation, and behavioral interventions, show promise but remain underexplored in combined applications. Furthermore, disparities in research representation limit the generalizability of findings and highlight the need for inclusive clinical trials. Addressing these gaps through precision medicine, advanced biomarker monitoring technologies, and equitable healthcare strategies could transform the management of these complex comorbidities. By advancing our understanding of neuroinflammatory mechanisms and promoting integrated interventions, this review underscores the need for a collaborative, patient-centered approach to improve outcomes and reduce the global burden of psychiatric and internal disease comorbidities.

Loneliness and repetitive negative thinking mediate the link between social health and cardiac distress in heart disease patients

Cardiovascular diseases are the leading cause of mortality worldwide, contributing to one-third of global deaths. Beyond physical health, heart disease is associated with cardiac distress, an emotional response that can negatively impact recovery and well-being. Understanding the psychological and social mechanisms underlying cardiac distress is crucial for improving patient outcomes. This study examines how social health (social support and social isolation) influences cardiac distress, with loneliness and repetitive negative thinking as mediators. To evaluate a theoretical model linking social health to cardiac distress, mediated by loneliness and repetitive negative thinking in patients with heart disease. A cross-sectional, correlational study was conducted in 2024 with 400 cardiac patients from two hospitals and one private clinic in Amol, Iran. Participants completed validated questionnaires assessing cardiac distress, social support, social isolation, loneliness, and repetitive negative thinking. Structural equation modeling was used for data analysis. Social isolation (r = 0.47, p < 0.001) and repetitive negative thinking (r = 0.50, p < 0.001) were significantly associated with greater cardiac distress. Social support negatively predicted both loneliness (β = - 0.32, p < 0.001) and cardiac distress (β = - 0.25, p < 0.01). Indirect effects showed that social support reduced cardiac distress by decreasing loneliness and repetitive negative thinking (β = - 0.23, p < 0.01), while social isolation increased cardiac distress through its influence on loneliness and repetitive negative thinking (β = 0.18, p = 0.05). The model explained 47.4% of the variance in cardiac distress. These findings highlight the importance of social health in managing cardiac distress among heart disease patients. Strengthening social support may alleviate loneliness and reduce repetitive negative thinking, ultimately improving emotional well-being and health outcomes. Future research should explore targeted interventions addressing these psychosocial factors to effectively reduce cardiac distress.

Impact of Rehabilitation Intervention for Cancer Patients with Spinal Bone Metastasis: Psychosocial and Clinical Outcomes

Background/Objectives: Cancer remains a significant global health issue in the 21st century, accounting for 16.8% of all deaths and 22.8% of noncommunicable disease (NCD) deaths globally. This study investigated the impact of a novel integrated rehabilitation intervention on clinical and psychosocial outcomes in cancer patients with vertebral metastasis. Methods: The three-year study included newly diagnosed oncological patients or those undergoing treatment, aged 18 years or older, with vertebral metastasis and spinal pain. The intervention was tailored to each patient based on mental and functional reserves, risk of vertebral fractures, physical reserves, fatigue, and ongoing oncological therapy. Results: The control and experimental groups were compared in terms of baseline characteristics, physical activity, tumor characteristics, pain, sphincter disorders, complications, survival, functional scores, and coping mechanisms. The experimental group demonstrated significantly better outcomes, including longer mean survival time (3.5 vs. 2.8 years, p < 0.001), higher Barthel Total Score (60.7 vs. 40.8, p = 0.002), and lower prevalence of fractures (20.0% vs. 55.4%, p < 0.001), osteoporosis (17.0% vs. 37.0%, p = 0.001), anemia (22.2% vs. 57.4%, p < 0.001), and vomiting (6.1% vs. 54.5%, p < 0.001). The experimental group also exhibited a lower reliance on avoidant coping strategies (29.0 vs. 31.3, p < 0.001). Conclusions: The study provides robust evidence that a personalized rehabilitation intervention significantly improves survival, functional independence, and coping strategies in cancer patients with spinal bone metastasis.

Life satisfaction as compared with traditional risk factors in relation to incident cardiovascular diseases

BACKGROUND

Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors.

METHODS

The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R2 values.

RESULTS

During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63-2.07] for CVD, 1.83 [1.59-2.10] for CHD, and 1.74 [1.31-2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (P < 0.05), while satisfaction with personal health showing the strongest association.

CONCLUSIONS

This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.

Sources of well-being and cardiovascular health: A mixed methods investigation from the MIDUS study

OBJECTIVE

Using mixed methods, we investigated whether different sources of well-being were associated with better cardiovascular health.

METHODS

Data came from adults (55% women; 19% Black, 75% White) with biomarker data from the Midlife in the United States (MIDUS) Study. At the second wave and in a refresher cohort, participants answered the question "What do you do to make your life go well?" Judges evaluated each response for the presence of 12 sources of well-being (e.g., positive relationships, faith, health maintenance). Participants were also assessed on 8 components of cardiovascular health at two waves, an average of 12 years apart. Concurrent (N = 2036) and longitudinal (N = 650) linear regressions examined the association between each well-being source in unadjusted models and models adjusted for sociodemographic factors and word count.

RESULTS

Adults who wrote about positive relationships, positive attitudes, enjoyment, coping, health maintenance, and planning tended to have better cardiovascular health in unadjusted models concurrently and longitudinally. In fully adjusted models, health maintenance (p < .001) and planning and organization (p = .004) were associated with better cardiovascular health concurrently. Additionally, health maintenance (p = .03) and work (p = .04) were associated with better cardiovascular health longitudinally.

CONCLUSIONS

Individuals who endorsed maintaining their health as central to well-being showed healthier cardiovascular outcomes 12 years later. Combining qualitative assessments of sources of well-being with clinically assessed measures of cardiovascular health highlights unique contributors of well-being that are relevant for health and may not be evident with conventional self-report measures.

Mental Health Care for Children with Heart Disease and Their Families: Practical Approaches and Considerations for the Pediatric and Pediatric Cardiology Clinician

Mental health conditions are a common comorbidity among children living with heart disease. Children with congenital heart disease are more likely to have a mental health condition than their unaffected peers or peers with other chronic illnesses, and mental health risk persists across their lifetime. While poorer mental health in adults with congenital heart disease is associated with worse overall health outcomes, the association between mental health and cardiac outcomes for children with heart disease remains unknown. Despite this, it is suspected that mental health conditions go undiagnosed in children with heart disease and that many affected children and adolescents do not receive optimal mental health care. In this article, we review mental health in congenital heart disease across the lifespan, across domains of care, and across diagnoses. Further directions to support mental health care for children and adolescents with heart disease include practical screening and access to timely referral and mental health resources.

Exploring the link between physical activity and professional quality of life among nurses: a cross-sectional study in Qatar

BACKGROUND

Physical activity (PA) is crucial for maintaining physical and mental health, particularly for healthcare professionals like nurses, whose demanding roles can impact their well-being. Professional Quality of Life (ProQOL) reflects caregiving roles' positive and negative outcomes, encompassing compassion, satisfaction, burnout, and trauma stress. This study explores the association between physical activity and ProQOL among nurses in Qatar.

METHODS

A quantitative, analytical, cross-sectional study was conducted among nurses working at Hamad Medical Corporation (HMC), with a sample size of 384, selected from approximately 10,000 nurses. Data was collected via an online survey using validated tools: the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Professional Quality of Life Scale (ProQOL-5). Descriptive statistics, chi-square tests, and ANOVA were applied to analyze associations between PA levels, ProQOL, and various sociodemographic, occupational, and health-related factors.

RESULTS

A total of 430 nurses participated (82.1% female, mean age: 43.3 ± 7.2 years). Most participants reported engaging in low (46.5%) or moderate (51.6%) physical activity levels. Moderate PA was significantly associated with higher ProQOL scores, particularly compassion satisfaction (40.3 ± 6.3), compared to low (36.9 ± 7.2) and high PA levels (38.7 ± 6.9). Burnout showed no significant association with PA levels. Sociodemographic factors, including age and shift patterns, were associated with PA, with moderate PA being more common among slightly older nurses and those working 8-hour shifts.

CONCLUSION

Moderate physical activity positively associates with nurses' professional quality of life, particularly by enhancing compassion satisfaction. While burnout did not show any significant relationship with PA, other factors like organizational support and work environment may play a more pivotal role. Promoting moderate PA among nurses through workplace interventions and supportive policies could enhance their well-being and caregiving capacity.

CLINICAL TRIAL NUMBER

Not applicable.

The heart's silver lining: Positive psychological well-being and health related quality of life in patients with heart failure

OBJECTIVE

Psychological distress, including depression, is linked to poor health outcomes in cardiovascular disease. Emerging evidence suggests that positive psychological well-being (PPWB), including optimism and purpose, may also impact health outcomes. However, the role of PPWB in heart failure (HF), a highly prevalent and progressive condition that severely affects health-related quality of life (HRQoL), remains unclear. This study explored the association between PPWB and HRQoL in patients with HF.

METHODS

In this cross-sectional study, 101 patients with HF from a cardiac hospital completed validated measures of PPWB (BIT), depression (PHQ-9), disease-specific HRQoL (KCCQ-12), and generic HRQoL (SF-36). Spearman correlations and hierarchical multiple linear regression analyses were conducted, adjusting for sex, age, depression, and comorbidities (Charlson Comorbidity Index).

RESULTS

Participants (mean age = 68.2 ± 9.9; 36 % female; 76 % NYHA class II) reported moderate PPWB (BIT = 3.7 ± 0.7), "fair" disease-specific HRQoL (KCCQ-12 Total score = 61.3 ± 23), and below-average generic HRQoL (SF-36 General Health = 36.2 ± 19.4). PPWB was significantly positively correlated with all KCCQ-12 and SF-36 subscales, with the strongest correlation for SF-36 General Health (r = 0.58, p < .001). In multivariable models, higher BIT scores were associated with better HRQoL across domains, including KCCQ-12-QoL (β = 0.26, p = .012), KCCQ-12 Social Limitations (β = 0.26, p = .017), KCCQ-12 Total score (β = 0.21, p = .042), SF-36 Energy (β = 0.38, p < .001), and SF-36 General Health (β = 0.48, p < .001).

CONCLUSION

PPWB is significantly associated with both disease-specific and generic HRQoL in patients with HF, even after adjusting for comorbidities and depression. These findings highlight the importance of focusing on well-being, not just distress, in future HF research.

A randomized controlled trial of meditation and health education on carotid intima-media thickness and major adverse cardiovascular events in Black men and women

Introduction

Black Americans suffer from disproportionately high rates of cardiovascular disease (CVD). Psychosocial stress contributes to this disparity. Previous studies reported that the Transcendental Meditation (TM) technique reduced CVD risk factors, surrogate endpoints, and clinical events in high-risk populations. However, no study has evaluated the effects of stress reduction with meditation on surrogate CVD markers such as carotid intima-media thickness (cIMT) along with CVD clinical events. Therefore, this randomized clinical trial evaluated the long-term effects of meditation and health education (HE) on cIMT and CVD events in high-risk Black adults.

Materials and methods

Participants were Black women and men with CVD or at high risk who were randomized to either TM or HE. The primary outcome was a change in cIMT measured using B-mode ultrasound at baseline and 12 months. The main secondary outcome was major adverse cardiovascular events (MACE) at 5 years (maximum) of follow-up. Other secondary outcomes were MACE at 1 and 10 years of follow-up, blood pressure, and serum lipids after 1 year. Exploratory variables were a comparison of cIMT changes to historical controls and MACE after 14 years.

Results

There were 197 randomized participants, of whom 136 completed posttest for cIMT. After 1 year, the TM and HE groups showed average cIMT changes of -0.0004 and -0.0003 mm, respectively, with no significant difference between the groups. Additionally, there were no significant differences between the groups in lipid levels or BP. However, both TM and HE groups showed prevention of progression of cIMT compared to historical controls at 12 months. In the survival analysis of MACE, there was a 65% relative risk reduction in the TM group after 5 (maximum) years of follow-up (HR = 0.346; 95% CI = 0.134-0.893; p = 0.017). At 1 and 10 years of follow-up, there were significant risk reductions in the TM vs. HE group, which was not significant at 14 years (all yearly maximums).

Discussion

Both treatment groups demonstrated prevention of progression of cIMT over 12 months compared to historical controls. However, the TM group showed a relative risk reduction for MACE of 65% at 5 years. Therefore, as a lifestyle modification method, TM may be useful in the secondary prevention of CVD in this and possibly other high-risk groups.

Clinical trial registration

ClinicalTrials.gov, NCT05642936.

Life's Crucial 9 and NAFLD from association to SHAP-interpreted machine learning predictions

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Cardiovascular disease (CVD) and NAFLD share multiple common risk factors. Life's Crucial 9 (LC9), a novel indicator for comprehensive assessment of cardiovascular health (CVH), has not yet been studied in terms of its association with or predictive value for NAFLD. This study analyzed data from 10,197 participants in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. The association between LC9 and NAFLD was assessed using weighted logistic regression, while weighted Cox proportional hazards models were applied to evaluate the relationship between LC9 and all-cause mortality among NAFLD patients. Restricted cubic spline (RCS) analysis was conducted to explore dose-response relationships, and Kaplan-Meier survival curves were utilized to examine differences in survival outcomes. Machine learning (ML) approaches were employed to construct predictive models, with the optimal model further interpreted using SHapley Additive exPlanations (SHAP). An increase of 10 points in LC9 was negatively associated with the risk of NAFLD (model 3: OR = 0.39, 95% CI = 0.36 - 0.42, P < 0.001) and all-cause mortality in NAFLD patients (model 3: HR = 0.78, 95% CI = 0.67 - 0.91, P < 0.001). A non-linear relationship was observed between LC9 and NAFLD (P < 0.0001 for nonlinearity). Among the eight ML models, the Support Vector Machine (SVM) demonstrated the best predictive performance (AUC = 0.873). SHAP analysis indicated that LC9 was the most significant predictor in the model. LC9 demonstrated a nonlinear negative association with NAFLD and a linear negative association with all-cause mortality in NAFLD patients. Maintaining a higher LC9 score may reduce the risk of NAFLD and all-cause mortality among NAFLD patients. The predictive model developed using Support Vector Machine (SVM) exhibited strong clinical predictive value, with LC9 being the most critical factor in the model, facilitating self-risk assessment and targeted intervention.

Effects of combining positive psychological intervention and lifestyle intervention on improving cardiovascular health for at-risk older adults: study protocol of a Chinese multicentric community-based randomised controlled trial (ACCOMPLI-CH)

INTRODUCTION

Cardiovascular health is influenced by various factors, including not only physiological and behavioural ones but also psychological well-being. However, when developing comprehensive preventive approaches, psychological interventions often receive less attention, despite their possible multiple mechanisms on cardiovascular health. Incorporating both healthy behaviour and psychological well-being promotion would be a more efficacious preventive approach. This study aims to investigate the effects of a community-based multicomponent intervention combining positive psychological intervention and lifestyle intervention on improving cardiovascular health among older adults with risk factors of cardiovascular diseases.

METHODS AND ANALYSIS

This study is a multicentre, community-based, randomised controlled trial with 18 months of intervention and follow-up for community-dwelling older adults aged 60 years and above with risk factors for cardiovascular health. Intervention activities last 6 months and are composed of in-person group training sessions of 60-80 min led by trained group instructors and weekly self-monitoring homework. Participants are randomly assigned to a multicomponent intervention 'Harmony' group (24 sessions of positive psychology and lifestyle intervention delivered weekly), an active control 'Lifestyle' group (eight sessions of lifestyle intervention delivered every 3-4 weeks) or a waitlist control group (no intervention activities). Positive psychological training sessions are designed using well-known techniques derived from positive psychology theories with adaptations to Chinese culture, and lifestyle training sessions are developed according to national guidelines. The primary outcome includes the change of a composite score of systolic blood pressure, total cholesterol, high-density lipoprotein and low-density lipoprotein levels, as well as psychological well-being measured from three perspectives, including hedonic, eudaimonic and evaluative well-being. Secondary assessments include other measures for physical and biological indicators, psychological well-being, health behaviours, social connection factors and overall cognitive functions. Primary data analyses will follow the intention-to-treat principle. To examine the effects of intervention, multilevel mixed models will be performed. In case of any differences in baseline participant characteristics, they will be adjusted for as covariates.

ETHICS AND DISSEMINATION

A centralised ethics review process was conducted, and the study protocol was approved by the ethics committee of the Institutional Review Board of the Institute of Psychology, Chinese Academy of Sciences in April 2022. A signed written informed consent form will be obtained from all participants. On completion, the trial results will be disseminated through published manuscripts and presentations at scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2200062929.

A biopsychological network approach to variables contributing to preoperative quality of life in patients undergoing cardiac surgery

Quality of life (QoL) in cardiac surgery patients is increasingly recognized as a critical outcome, influenced by biopsychosocial variables. This study aims to explore the associations between preoperative QoL and various psychological and biomedical variables in patients undergoing cardiac surgery. The study includes cross-sectional baseline data from 204 cardiac surgery patients in two distinct cardiac surgery samples: Data collection for the PSY-HEART I trial (coronary artery bypass grafting) was conducted from 2011 to 2015, while data for the ValvEx (valvular surgery) trial were collected between 2020 and 2022. We assessed psychological variables, such as illness beliefs and expectations, alongside biomedical variables, including body mass index, EuroSCORE II, and C-reactive protein levels. Data analysis involved partial correlation Gaussian Graphical Models (GGM) and Directed Acyclic Graphs (DAGs) to identify key nodes and pathways affecting QoL. The resulting GGM was estimated to be rather sparse (38 of 136 possible edges were present) and the case-drop bootstrap node stability estimates ranged from sufficient (CS-Coefficient Bridge Expected Influence = 0.28) to good (CS-Coefficient Expected Influence = 0.51). Our analyses revealed strong associations between psychological variables and preoperative QoL, with current and expected illness-related disability being central to the network. Medical variables showed weaker connections to QoL. The DAG indicated that expected disability influenced current disability and preoperative QoL, suggesting that preoperative expectations may be crucial for postoperative outcomes. This study underscores the importance of psychological variables, particularly illness perceptions and expectations, in determining QoL in cardiac surgery patients. Targeting these variables through preoperative interventions may enhance postoperative recovery and QoL, advocating for a biopsychosocial approach in cardiac surgery care.

Optimizing Psychological Health Across the Perinatal Period: An Update on Maternal Cardiovascular Health: A Scientific Statement From the American Heart Association

Perinatal psychological health conditions (eg, perinatal depression, anxiety) are some of the leading causes of maternal mortality in the United States and are associated with adverse pregnancy outcomes, long-term cardiovascular outcomes, and intergenerational effects on offspring neurodevelopment. These risks underscore the importance of addressing maternal psychological health as a key determinant of perinatal cardiovascular health. Thus, it is vital to recognize the spectrum of perinatal psychological health and to provide guidance for both patients and clinicians on screening and management options across the perinatal period. In this scientific statement from the American Heart Association, we redefine maternal cardiovascular health to include psychological health, provide robust evidence on the association of psychological health with cardiovascular outcomes, highlight the social and environmental underpinnings, and finally, offer guidance about how to integrate psychological health into maternal cardiovascular health with a specific focus on the perinatal period (ie, pregnancy through 1 year postpartum). We also describe opportunities for creating care delivery models that recurrently address perinatal psychological health in cardio-obstetric care, using behavioral and pharmacological interventions, with an emphasis on better integration of psychological health care, longer postpartum follow-up, and opportunities for evaluating the comparative effectiveness of these models with stakeholder partners.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation: Cochrane systematic review and meta-analysis

AIMS

Depression and anxiety occur frequently in individuals with cardiovascular disease and are associated with poor prognosis. This Cochrane systematic review and meta-analysis assessed the effectiveness of psychological interventions on psychological and clinical outcomes in adults with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF).

METHODS AND RESULTS

CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases were searched from January 2009 to July 2022 for randomized controlled trials of psychological interventions vs. controls in adults with CHD, HF, or AF. Twenty-one studies (n = 2591) were assessed using random-effects models. We found psychological interventions reduced depression [standardized mean difference (SMD) -0.36; 95% confidence interval (CI) -0.65 to -0.06; P = 0.02], anxiety (SMD -0.57; 95% CI -0.96 to -0.18; P = 0.004), and improved mental health-related quality of life (HRQoL) (SMD 0.63, 95% CI 0.01 to 1.26; P = 0.05) (follow-up 6-12 months), but not physical health-related quality of life, all-cause mortality or major adverse cardiovascular events compared with controls. High heterogeneity was present across meta-analyses. Meta-regression analysis showed that psychological interventions designed to target anxiety, were more effective than non-targeted interventions.

CONCLUSION

This review found that psychological interventions improved depression, anxiety and mental HRQoL, with those targeting anxiety to show most benefit. Given the statistical heterogeneity, the precise magnitude of effects remains uncertain. Increasing use of multifactorial psychological interventions shows promise for incorporating patient needs and preferences. Investigation of those at high risk of poor outcomes, comparison of intervention components and those with AF is warranted.

Clinical neurocardiology: defining the value of neuroscience-based cardiovascular therapeutics - 2024 update

The intricate role of the autonomic nervous system (ANS) in regulating cardiac physiology has long been recognized. Aberrant function of the ANS is central to the pathophysiology of cardiovascular diseases. It stands to reason, therefore, that neuroscience-based cardiovascular therapeutics hold great promise in the treatment of cardiovascular diseases in humans. A decade after the inaugural edition, this White Paper reviews the current state of understanding of human cardiac neuroanatomy, neurophysiology and pathophysiology in specific disease conditions, autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases.

Estradiol levels are differentially associated with pulse wave velocity in trauma-exposed premenopausal women with and without PTSD

Arterial stiffness is a well-known risk factor for cardiovascular disease. Although estradiol (E2) is known to be cardioprotective, the available data point to a growing cardiovascular disease risk in women before menopause due to posttraumatic stress disorder (PTSD). The present study aimed to investigate the effects of E2 on arterial compliance in trauma-exposed premenopausal women, with and without a clinical diagnosis of PTSD. We hypothesized that E2 will be differentially associated with pulse wave velocity (PWV) in women with PTSD (PTSD+, n = 45) and without PTSD (PTSD-, n = 47). Estradiol and PWV were measured during two separate study visits. Serum E2 levels were measured via the quantitative sandwich enzyme-linked immunoassay technique (ELISA) and log-transformed due to non-normal distribution. Carotid to femoral applanation tonometry was used to measure PWV. Our analyses revealed an overall weak and nonsignificant correlation between E2 and PWV (r = -0.119, P = 0.350). However, when examining each group, we found a negative association between E2 and PWV in PTSD- (r = -0.466, P = 0.004). In contrast, we found an unexpected positive association between E2 levels and PWV in PTSD+ (r = 0.360, P = 0.037). Furthermore, a multiple linear regression revealed that E2 was predictive of PWV in PTSD- only, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity (R2 = 0.670, P = 0.005). Interestingly, we also found lower levels of E2 in PTSD+ than PTSD- (1.4 ± 0.4 vs. 1.6 ± 0.4 pg/mL, P = 0.022). These findings suggest that PTSD may inhibit the protective effects of E2 on arterial compliance in women before menopause.NEW & NOTEWORTHY In trauma-exposed premenopausal women, we found that serum estradiol (E2) was a predictor of pulse wave velocity (PWV) only in the absence of a posttraumatic stress disorder (PTSD) diagnosis, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity. Moreover, E2 levels were lower in women with PTSD than in those without PTSD. We collected E2 and PWV during two separate visits and controlled for the menstrual cycle phase in our analyses.

Cognitive behavioural therapy targeting cardiac anxiety post-myocardial infarction: results from two sequential pilot studies

Aims

Cardiac anxiety, which is cardiac-related fear and avoidance behaviours, is common following myocardial infarction (MI) and has been associated with increased risk for cardiovascular events. However, there are currently no treatments specifically designed to target cardiac anxiety. The aim of the two pilot studies was to evaluate an exposure-based cognitive behavioural therapy protocol (MI-CBT) targeting cardiac anxiety following MI, assessing feasibility, acceptability, and the intervention's potential for reducing cardiac anxiety and improving health-related quality of life (QoL).

Methods and results

A series of two sequential, uncontrolled pilot studies were conducted. In Pilot Study 1 (n = 15), MI-CBT was delivered via face-to-face videoconference, while Pilot Study 2 (n = 23) was delivered online. Patients with a history of MI (≥6 months before assessment, type 1 ST- or non-ST-segment elevation MI, and elevated cardiac anxiety as per clinical interview) were included. The interventions lasted 8 weeks and were therapist-led, with key components including exposure to cardiac-related symptoms and reduction of avoidance behaviours. Participants completed self-rated assessments, including the Cardiac Anxiety Questionnaire (CAQ) and the 12-Item Short Form Health Survey (SF-12), at baseline, post-treatment, and 6-month follow-up. Treatment adherence and satisfaction were high. Cognitive behavioural therapy led to a large reduction in cardiac anxiety, as measured by the CAQ (P < 0.001), and significant improvements in health-related QoL, as measured by the SF-12 (P < 0.001), in both pilot studies.

Conclusion

These studies suggest that exposure-based CBT is a feasible, acceptable, and promising approach to reduce cardiac anxiety and improve QoL following MI. A randomized controlled trial should be conducted to evaluate the efficacy of the intervention.

Interactions of chronic stress exposure and stress appraisal on vascular endothelial function among young adults

We investigated the associations of ongoing, chronic stress exposure and stress appraisal on vascular endothelial function (VEF) in young adults. In 72 healthy young adults (74% female; age = 25 ± 1 yr), we assessed chronic stress exposure and appraisal with a measure that quantified chronic stress exposure and chronic stress appraisal related to eight specific stressors over the last year. Participants completed the perceived stress scale (PSS) as a measure of global, proximal stress appraisal. VEF was assessed using the brachial artery flow-mediated dilation technique. We examined relations among ongoing, chronic stress exposure and stress appraisal versus VEF adjusted for age and sex, and then assessed whether stress appraisal moderated the effect of chronic stress exposure on VEF. Chronic stress exposure (β = -0.24, P = 0.045), but not chronic stress appraisal (β = 0.07, P = 0.56) or perceived stress (β = -0.20, P = 0.11), was related to VEF. Perceived stress (P = 0.046), but not chronic stress appraisal (P = 0.54), moderated the association between chronic stress exposure and VEF. The effect of chronic stress exposure on VEF ceased to be significant at a PSS score of ∼22. Subsequent exploratory stratified analysis indicated that those with PSS ≥22 had increased exposure to adverse childhood experiences (+1.6 ± 0.6, P = 0.01), greater depressive symptoms (+10.2 ± 2.7, P < 0.001), and reduced psychological resilience (-7.6 ± 3.5, P = 0.036). Chronic stress exposure significantly predicts impaired VEF among young adults. Furthermore, this relation is influenced by proximal perceived stress, such that the association of chronic stress exposure on VEF may be obscured at high levels of proximal perceived stress.NEW & NOTEWORTHY Our findings indicate that ongoing chronic stress exposure over the last year is significantly associated with reduced vascular endothelial function among apparently healthy young adults. Our data provide important insights into the interplay of chronic stress exposure versus proximal perceived stress and may also support the hypothesis that young adults who are sensitized to stress may be particularly vulnerable to stress-related impairments in vascular endothelial function.

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation: Endorsed by the American College of Cardiology

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.

Association between polysocial risk score and CVH among women of reproductive age in the SAFE HEART study: An American Heart Association Research Goes Red Initiative

BACKGROUND

To assess the association between polysocial risk factors and cardiovascular health (CVH) among women of reproductive age.

METHODS

Our cross-sectional analysis included women of reproductive age (18-44 years) from community settings and the American Heart Association's Research Goes Red (RGR) registry. Polysocial risk scores (0-14) reflected social disadvantage across domains including socioeconomic stability (education, employment, income, insurance, financial strain), living situation (housing stability, housing quality, marital status, home ownership), food security, transportation, utilities, and interpersonal safety. Suboptimal CVH was defined as having ≥2 risk factors from Life's Essential 8 metrics: physical activity, diet, body mass index, sleep, smoking, blood pressure, blood sugar, and cholesterol. Associations between polysocial risk and suboptimal CVH were analyzed using linear regression models RESULTS: Suboptimal CVH increased with higher polysocial risk, from 77.0 % in the lowest quartile to 95.2 % in the highest. Participants in quartile 3 had the highest odds of suboptimal CVH (aOR 9.52, 95 % CI 2.63-34.46), while quartile 4 showed decreased but significant odds (aOR 3.86, 95 % CI 1.03-14.40) compared to quartile 1. Hypertension (aOR 10.23, 95 % CI 3.61-29.01), diabetes (aOR 8.87, 95 % CI 3.12-25.24), hyperlipidemia (aOR 7.48, 95 % CI 2.72-20.55), and smoking (aOR 9.46, 95 % CI 3.25-27.56) were strongly associated with higher polysocial risk in community-enrolled participants, whereas trends were less consistent in RGR-enrolled participants.

CONCLUSIONS

Women with higher social risks face greater odds of suboptimal CVH. Screening for social determinants and tailored public health interventions are essential for mitigating CVH risks in this population.

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.

Mental health status and quality-of-life after an acute myocardial infarction with non-obstructive coronary arteries or takotsubo syndrome: A systematic review

BACKGROUND

Myocardial infarction with non-obstructive coronary arteries (MINOCA) and takotsubo syndrome (TS) are both characterised by lack of significant coronary artery stenoses and a higher prevalence of mental health disorders preceding the event. Currently, little is known about their pathological aetiologies and subsequent treatment plans, giving cause for concern among those affected. The objective of this review is to provide a comprehensive overview of mental health status and quality of life (QoL) in MINOCA- and TS-patients after the acute event, compared to both cardiac and non-cardiac populations, and over time.

METHODS

A systematic search was conducted via Cochrane Library, CINAHL, PyschINFO, PubMed, ASSIA, Web of Science, Scopus and Embase from inception to May 2024. The review was registered in PROSPERO and methods, and results were reported in accordance with the PRISMA guidelines. Quality assessment and risk of bias were evaluated using the Newcastle-Ottawa Scale for cross-sectional and cohort studies.

RESULTS

Sample sizes ranged from 13 to 5,322 participants. The risk of bias was high in 18/28, medium in 7/28, and low in 3/28 studies. Across the symptoms assessed, MINOCA- and TS-patients reported worse mental health status or QoL than non-cardiac groups in 10/13 studies, and cardiac groups in 10/20 studies. Investigating change over time, 1/5 studies found deteriorating mental health status, 3/5 reported improved mental health status or QoL and 1/5 reported no change in MINOCA- and TS-patients.

CONCLUSIONS

Patients with MINOCA or TS seem to have worse mental health status and QoL after the acute event than non-cardiac individuals, but it is yet difficult to conclude whether mental distress and QoL are equal or worse compared to CHD-patients. There is no convincing evidence that mental health status or QoL of MINOCA- and TS- patients naturally improve over time after the acute event. Among the studies evaluated, risk of bias was high. More high-quality studies are needed, investigating mental health status and QoL among MINOCA- and TS-patients.

Effect of Positive Mental Health on Elderly Patients with Chronic Diseases: The Chain-Mediated Effects of Gratitude and Forgiveness Tendencies at a Tertiary Hospital in Guangzhou

Background: This study aims to elucidate the mediating roles of gratitude and forgiveness tendency between mature happiness and positive mental health, seeking to reveal the significance of enhancing these psychological traits to enhance the well-being of this population, so as to provide a theoretical foundation for strategies aimed at promoting healthy aging and enhancing the happiness of elderly patients with chronic illness. Methods: From April to October 2024, elderly patients with chronic diseases in the geriatric department of a tertiary hospital in Guangzhou China were selected as subjects through convenience sampling. The study utilized the general information questionnaire, the Chinese Version of Mature Happiness Scale-Revised, the Positive Mental Health Scale, the Gratitude Questionnaire-6, and the Tendency to Forgive Scale for data collection. Results: A total of 319 valid questionnaires were obtained. The mature happiness, positive mental health, gratitude, and forgiveness tendency of elderly patients with chronic diseases were at a medium level. Correlation analysis indicated that mature happiness was positively associated with positive mental health, gratitude, and forgiveness tendency. Mediation analysis illuminated that positive mental health robustly predicted the extent of gratitude, which served as a pivotal predictor of mature happiness. Moreover, gratitude and forgiveness tendency together played a significant chain mediating role between mature happiness and positive mental health, accounting for 26.31% of the total effect (p = 0.246). Conclusions: Positive mental health has a significant positive impact on mature happiness amongst elderly patients with chronic diseases, mediated through the chain mediating effects of gratitude and forgiveness tendency. Consequently, fostering traits of gratitude and forgiveness in this population may enhance their mental health and mature happiness.

Mind-body therapy for cardiometabolic risk in U.S. middle-aged Black adults: a scoping review

Background

In the U.S., Black adults do not achieve the same life expectancy as their White counterparts, and this is attributable in large part to the development of cardiovascular disease (CVD). Mind-body therapy (MBT) interventions demonstrate improvements in cardiometabolic risk (CMR) factors that promote CVD, with increased feasibility and acceptability in the general population. Less known is the feasibility, acceptability, and evidence of reduction in CMR factors in the U.S. Black population with MBT.

Purpose

This study aimed to synthesize the current state of research regarding MBT on CMR factors in middle-aged U.S. Black adults and identify gaps in the literature. Research Question 1: What types of studies have been conducted (study design, theoretical framework, and cultural relevance)? and Research Question 2: What is the feasibility and acceptability and effectiveness of MBT in Black adults for CMR reduction?

Methods

Following PRISMA-ScR guidelines, a review of three databases was conducted. Our inclusion criteria were articles that (1) describe empirical research; (2) assessed a MBT intervention in middle-aged (35-64) adults with a minimum of 60% Black adult participants for CMR reduction; and (3) written in English. Independent reviewers selected articles for inclusion and data extraction, with a third reviewer providing consensus.

Results

Fourteen articles met the eligibility criteria (n = 14). Characteristics included randomized controlled trials (8, 57.1%); single-arm (3, 21.0%); mixed methods (3, 21.0%); sample size (17-375); mean age range 43-64; female (6, 42.8%); theoretical framework (4, 28.6%); culturally adapted (7, 50.0%); and studies demonstrating feasibility and/or acceptability (7, 50.0%). Of the seven articles assessing CMR physiologic factors, five studies observed significant improvement. For the 11 studies assessing CMR psychological factors, 6 studies had statistically significant results and 3 studies identified trends toward positive statistical outcomes.

Implication

A growing body of literature across research stages demonstrating acceptability, and feasibility, and evidence of effectiveness for selected outcomes of MBT in middle-aged Black adults with CMR factors shows promise. Future research recommendations include greater recruitment of Black men for MBT studies, larger sample sizes, and utilizing culturally adapted interventions for engaging Black adults in MBT for reduced CMR factors.

Causal associations between posttraumatic stress disorder and type 2 diabetes

Posttraumatic stress disorder (PTSD) patients have a high comorbidity with type 2 diabetes (T2D). Whether PTSD influences the risk of diabetes is still not known. We used GWAS data from European ancestry of PTSD (23,121 cases and 151,447 controls) and T2D (80,154 cases and 853,816 controls) to investigate the bidirectional associations between PTSD and T2D by the Mendelian randomization (MR) analysis. We showed that PTSD was causally associated with higher odds of T2D (OR = 1.04, 95% CI: 1.01-1.06, P = 0.0086), but not vice versa. Our study suggests that PTSD may increase the risk of T2D. PTSD sufferers should be screened for T2D and its precursor known as metabolic syndrome.

Association of dietary intake of saturated fatty acids with obstructive sleep apnea: mediating effects of Life's Crucial 9

Introduction

Obstructive sleep apnea (OSA) is a global public health issue. Life's Crucial 9 (LC9) is recognized as a powerful tool for assessing cardiovascular health. Although the etiology of OSA remains unclear, saturated fatty acids (SFAs) and cardiovascular health are increasingly regarded as a non-negligible element. This study aims to assess the association between dietary intake of SFAs and the risk of OSA, and the mediating effect of LC9.

Methods

Based on the National Health and Nutrition Examination Survey (NHANES), dietary questionnaires of participant were collected, and the average values of 24-h dietary recall data over 2 days were obtained. A continuous cross-sectional analysis with dietary energy adjustment was employed. Weighted multivariable logistic regression models were used to estimate the weighted odds ratios (ORs) and their 95% confidence intervals (CIs) for SFAs and OSA. Evaluate the mediating role of LC9 in the relationship between SFAs and OSA.

Results

A total of 13,563 participants aged 20 years and above were included in this study. The intakes of Sfa 4.0 and LC9 among participants with OSA were significantly lower than those in the normal population. After adjusting for confounding factors, total SFAs could increase the risk of OSA [Model 1, Q3, 0.03, 1.49 (1.03, 2.15); Model 2, Q3, 0.04, 1.47 (1.01, 2.13)]. It was emphasized that dietary intake of Sfa 12.0, Sfa 14.0, and Sfa 16.0 were protective factors for OSA, especially among participants aged 45-64 years and white individuals. Moreover, Sfa 12.0 exhibited a better protective effect in female participants [Q3, 0.04, 0.66 (0.45, 0.99)]. In addition, the cardiovascular health score - LC9 had a mediating effect in Sfa4.0 on OSA [Proportion of mediation: -0.035, 95% CI: (-0.058, -0.01); p= 0.002]. There was a nonlinear relationship between dietary intake of Sfa 12.0, Sfa 16.0, and Sfa 18.0 and OSA (P-Nonlinear = 0.013).

Discussion

These findings suggest that dietary mixtures of saturated fatty acids increase the risk of OSA. Among them, SFA 4:0 can increase the risk of OSA through the level of cardiovascular health. However, contrary to traditional beliefs, long-chain saturated fatty acids can reduce the risk of OSA.

Using the Hospital Anxiety and Depression Scale in Patients 80 Years-Old and Older: A Systematic Review

AIMS

To identify and report results from studies of anxiety and depression, as measured by The Hospital Anxiety and Depression Scale (HADS) in patients ≥ 80 years admitted to hospital settings, and to inform nurses, researchers and educators in nursing about these findings.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Epistemonikos, Scopus and Web of Science Core Collection of studies published until October 2023.

METHODS

A search strategy was developed with a university librarian. Four independent reviewers screened titles and abstracts based on predefined inclusion criteria. Data were systematically extracted, descriptively analysed, and Critical Appraisal Skills Programme checklists were used to assess studies.

RESULTS

Out of 7076 identified studies, three met the eligibility criteria. Data from 420 participants aged ≥ 80 years were analysed, revealing anxiety prevalence rates between 6% and 18% and mean scores below 4. Depression prevalence rates ranged from 7% to 17%, with a mean score below 4. Most patients with depression were not previously recognised as being depressed.

CONCLUSIONS

Few publications reported on anxiety and/or depression in hospitalised patients aged ≥ 80 years using HADS. A gap in the knowledge base has been identified.

IMPLICATIONS

Anxiety and depression are mental health conditions that can lead to adverse events and strongly affect aging. Increased understanding of the role that these conditions have on hospitalised patients ≥ 80 years is important for nurses when in contact with this patient group.

IMPACT

There is a need for more studies to generate evidence regarding anxiety and depression in an increasingly common and challenging hospital population by building upon evidence that is based on validated instruments such as the Hospital Anxiety and Depression Scale.

REPORTING METHOD

The PRISMA guideline was followed, and the review registered in PROSPERO (Registration number CRD 42022380943).

PATIENT CONTRIBUTION

No patient or public contribution.

TRIAL REGISTRATION

CRD 42022380943.

Persistent PTSD symptoms are associated with plasma metabolic alterations relevant to long-term health: A metabolome-wide investigation in women

BACKGROUND

Post-traumatic stress disorder (PTSD) is characterized by severe distress and associated with cardiometabolic diseases. Studies in military and clinical populations suggest that dysregulated metabolomic processes may be a key mechanism. Prior work identified and validated a metabolite-based distress score (MDS) linked with depression and anxiety and subsequent cardiometabolic diseases. Here, we assessed whether PTSD shares metabolic alterations with depression and anxiety and if additional metabolites are related to PTSD.

METHODS

We leveraged plasma metabolomics data from three subsamples nested within the Nurses' Health Study II, including 2835 women with 2950 blood samples collected across three time points (1996-2014) and 339 known metabolites assayed by mass spectrometry-based techniques. Trauma and PTSD exposures were assessed in 2008 and characterized as follows: lifetime trauma without PTSD, lifetime PTSD in remission, and persistent PTSD symptoms. Associations between the exposures and the MDS or individual metabolites were estimated within each subsample adjusting for potential confounders and combined in random-effects meta-analyses.

RESULTS

Persistent PTSD symptoms were associated with higher levels of the previously developed MDS. Out of 339 metabolites, we identified 29 metabolites (primarily elevated glycerophospholipids and glycerolipids) associated with persistent symptoms (false discovery rate < 0.05; adjusting for technical covariates). No metabolite associations were found with the other PTSD-related exposures.

CONCLUSIONS

As the first large-scale, population-based metabolomics analysis of PTSD, our study highlighted shared and distinct metabolic differences linked to PTSD versus depression or anxiety. We identified novel metabolite markers associated with PTSD symptom persistence, suggesting further connections with metabolic dysregulation that may have downstream consequences for health.

Conceptual competence in medicine: promoting psychosomatic awareness in clinics, research and education

Introduction

In recent decades, psychosomatic medicine has developed into a distinct specialty, bringing specific clinical concepts to bear seeking to acknowledge the unity (not the identity) of the mind and body in clinical care. Such concepts form the identity of the psychosomatic field as a distinct discipline and its epistemological status between somatic medicine and psychiatry. Despite the importance of these concepts from an educational and a research perspective, too little attention has been paid to their clinical impact.

Methods

This paper investigated the general nature of concepts and their role and significance in structuring the clinical encounter and care, including consideration of their relevance for the hidden curriculum.

Results

Conceptual competence is defined as a transformative awareness of the multilayered, fallible, and plural nature of human concepts, which have both descriptive and evaluative and action-guiding properties having both an explicit and an implicit meaning. Conceptual competence in psychosomatic medicine entails dealing competently with the mind-body-distinction and the biopsychosocial model (and criticism of it) with respect to the clinical situation.

Discussion

Conceptual research is presented as an autonomous research area and the complement of empirical research, having a descriptive and a normative function: descriptively analyzing the concepts we have and normatively searching for the concepts that we need for the integrated care we strive for.

Association of depressive symptoms and cardiovascular health with mortality among U.S. adults

BACKGROUND

Depression and cardiovascular health (CVH) are interconnected, and both are independently associated with mortality. However, the joint effects of depressive symptoms and CVH on mortality remain unclear.

METHODS

By utilizing the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we included 18,679 adults aged ≥20 years without cardiovascular diseases (CVD). The definition of elevated depressive symptoms was based on the Patient Health Questionnaire-9 (PHQ-9) scores≥10. CVH was evaluated by Life's Essential 8 (LE8) and categorized into low (<50), moderate (50-80), or high (≥80). The joint association of depressive symptoms and CVH with mortality was examined utilizing multivariate Cox proportional hazard models.

RESULTS

Elevated depressive symptoms were associated with higher mortality risks, and CVH could explain 12.7 % and 13.7 % of the associations between depression and all-cause and non-CVD mortality, respectively. No significant interactions were found between CVH and depressive symptoms on mortality. High CVH attenuated the all-cause mortality risk in patients with elevated depressive symptoms (HR, 0.20; 95 % CI: 0.05-0.89). Compared to participants with elevated depressive symptoms and low CVH, those with no elevated depressive symptoms and high CVH had lower risks of all-cause (HR, 0.26; 95 % CI: 0.16-0.43), CVD (HR, 0.20; 95 % CI: 0.07-0.52), non-CVD mortality (HR, 0.28; 95 % CI 0.16-0.50).

CONCLUSION

Adults with low CVH and elevated depressive symptoms had significantly higher risks of all-cause, CVD, and non-CVD mortality. The finding suggests considering depressive symptoms and CVH jointly in developing targeted strategies to improve survival.

Brain Wave Oscillations as an Objective Neurophysiological Biomarker of Homeopathic Subjective Well-Being

BACKGROUND

 Homeopathy uses the "similitude principle" to arouse a therapeutic reaction in the body against its own disorders. For this to occur optimally, the medicinal pathogenetic effects must present similarity with the totality of the individual's symptoms. To assess if this similarity has been successfully achieved, Hahnemann states that "improvement in the disposition and mind"-i.e., subjective well-being-is the most important parameter to consider.

AIM

 Our aim was to perform a narrative review of the literature, exploring what is known about subjective well-being as a marker of therapeutic action, and to formulate ways in which subjective well-being might be quantifiable and applied in future homeopathy research.

RESULTS

 The concept of subjective well-being has been extensively studied in the complementary and conventional medical literature. Improved well-being has been observed in clinical trials, including those in the fields of positive psychology and meditation. Positive subjective outcomes of this nature are supported by objective evidence through associated changes in brain oscillatory activity using electroencephalography and/or "brain mapping" by functional magnetic resonance imaging. Neurophysiological responses in the brain have been identified in subjects after they ingested a homeopathic medicine.

CONCLUSIONS

 The concept of subjective well-being is supported by a body of literature and is a measurable entity. When viewed from the perspective of electrophysiological changes, brain activity is an objective neurophysiological biomarker with a potential to quantify individual well-being in the context of homeopathy research.

The relationship among heart health attitudes, socioeconomic factors, and HbA1c levels in adolescents with type 1 diabetes

BACKGROUND

Type 1 Diabetes is important chronic health problem that incidence increasing between the ages of 4-6 and 10-15, has multi-dimensional etiological factors. Cardiovascular diseases may develop due to diabetes and cause significant morbidity and mortality. Diabetes cause deterioration of vascular structure, and sudden onset of heart disease through various pathophysiological mechanisms. Controlling factors, especially diabetes management, is very important in preventing cardiovascular diseases.

OBJECTIVE

The study aimed to investigate the relationship between heart health attitudes, socioeconomic factors, and HbA1c levels in adolescents with Type 1 Diabetes.

METHODS

The study included 10-15-year-old adolescents with Type 1 Diabetes treated in pediatric endocrinology outpatient clinic provided they met the inclusion and exclusion criteria. Adolescents' heart health attitudes were evaluated with the cardiovascular health promotion attitude scale for children. HbA1c levels and socioeconomic characteristics of the adolescents were recorded.

RESULTS

The independent predictors of the group with favorable heart health attitudes were exercise duration, meal frequency, low economic status, and HbA1c levels. HbA1c levels were positively associated with nutrition, exercise, sedentary life, and smoking subscale scores as well as total scale scores. However, it was not associated with the scores of self-love and stress subscales. Low self-love and stress subscale scores were independent predictors of low economic status and explain why low economic status is a predictor of favorable heart health attitudes.

CONCLUSIONS

The cardiovascular health promotion attitude scale scores are associated with HbA1c levels, which is a predictor of increased cardiovascular diseases. This predictive ability of the scale makes its use meaningful.

Joint effect of modifiable risk factors on Parkinson's disease: a large-scale longitudinal study

Introduction

Previous researches have often underestimated the diversity and combined effects of risk factors for Parkinson's disease (PD). This study aimed to identify how multiple modifiable risk factors collectively impact PD.

Methods

The study included 452,492 participants from the UK Biobank, utilizing genetic data and 255 phenotypic variables. A broad exposure association study was conducted across seven domains: socioeconomic status, medical history, psychosocial factors, physical measures, early life, local environment, and lifestyle. Risk scores of each domain for each participant were generated. The joint effects of modifiable and genetic risks assessed using Cox proportional hazards model. Population attributable fraction (PAF) was estimated to quantify contribution ratio of risk factors in different domains to the occurrence of PD.

Results

Multiple risk factors significantly (p < 1.96 × 10-4) associated with PD was observed. The top 5 factors were hand grip strength (hazard ratio (HR) = 0.98, p = 1.59 × 10-24), long-standing illness (HR = 1.38, p = 3.63 × 10-20), self-reported nervousness (HR = 1.56, p = 5.9 × 10-20), ever suffered from mental health concerns (HR = 1.42, p = 5.48 × 10-18) and chest pain (HR = 1.42, p = 1.43 × 10-18). Individuals with unfavorable medical history, psychosocial factors, physical measures, and lifestyle had an increased risk of PD by 33 to 51% compared to those with favorable factors (p < 0.001).

Discussion

Results indicated that addressing modifiable risk factors, especially in physical measures and psychological factors, could potentially prevent up to 33.87% of PD cases. In formulating prevention strategies, it is recommended to prioritize domains such as physical measures, psychosocial factors, lifestyle, and medical history.

Survivorship After Cardiogenic Shock

Advances in critical care therapies for patients with cardiogenic shock (CS), including temporary mechanical circulatory support and multidisciplinary shock teams, have led to improved survival to hospital discharge, ranging from 60% to 70%. After their index hospitalization, however, survivors of CS may continue to face cardiac as well as extracardiac sequelae of these therapies and complications for years to come. Most studies in CS have focused primarily on survival, with limited data on long-term recovery measures among survivors. In other forms of critical illness, research indicates that many intensive care unit survivors experience impairments in multiple domains, such as cognitive function, physical ability, and mental health. These impairments, collectively referred to as Post-Intensive Care Syndrome, in turn impact survivors' quality of life and future prognosis. This review identifies unique aspects of CS-related survivorship, highlights lessons learned from other forms of critical illness, and outlines future research directions to determine specific strategies to enhance recovery and survivorship after CS.

Closing the Gap: Digital Innovations to Address Hypertension Disparities

PURPOSE OF REVIEW

Significant inequities persist in hypertension detection and control, with minoritized populations disproportionately experiencing organ damage and premature death due to uncontrolled hypertension. Remote blood pressure monitoring combined with telehealth visits (RBPM) is proving to be an effective strategy for controlling hypertension. Yet there are challenges related to technology adoption, patient engagement and social determinants of health (SDoH), contributing to disparities in patient outcomes. This review summarizes the evidence to date for RBPM, focusing on the potential to advance health equity in blood pressure control and the existing levers for largescale implementation.

RECENT FINDINGS

Several studies demonstrate the promise of RBPM programs to address health disparities through: (1) the use of cellular-enabled blood pressure machines that do not require internet access or smart devices to connect readings into the medical record; (2) emphasis on home blood pressure monitoring to illuminate the daily factors that influence blood pressure control, thereby increasing patient empowerment; (3) adoption of standardized algorithms for hypertension management; and (4) integration of services to address SDoH. Multidisciplinary, non-physician care teams that include nurses, pharmacists, and community health workers are integral to this model. However, most studies have not embraced all aspects of RBPM, and implementation is challenging as current payment models do not support the digital components of RBPM or a diverse workforce of hypertension providers.

CONCLUSION

To address hypertension disparities, RBPM programs need to integrate digital technology that is accessible to all users as well as multidisciplinary care teams that attend to the medical and social needs of populations experiencing health inequities.

Are the ways women cope with stressors related to their health behaviors over time?

OBJECTIVE

Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.

METHODS

Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.

RESULTS

Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.

CONCLUSIONS

Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

From worries to resilience: a qualitative study of the psychosocial experiences of diverse adolescents and young adults with heart failure and their caregivers

BACKGROUND AND OBJECTIVES

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers' perceptions, with specific focus on personal challenges, worries, coping skills, and resilience.

METHODS

Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers.

RESULTS

Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult's greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey.

CONCLUSIONS

This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers' perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.