Efficacy of Cognitive Behavior Therapy in Reducing Depression among Patients with Coronary Heart Disease: An Updated Systematic Review and Meta-Analysis of RCTs

The value of anxiety and depression in predicting physical function and major adverse cardiovascular events in patients with acute coronary syndrome

Background

Psychological distress, including anxiety and depression, is not only prevalent in patients with coronary heart disease (CHD) but can actually predict adverse clinical events. Therefore, the necessity of addressing psychological problems among patients with CHD to improve their treatment results is increasingly acknowledged. This study's objective was to examine the prognostic impact of anxiety and depression on major adverse cardiovascular events (MACEs) and physical function among patients with acute coronary syndrome (ACS).

Methods

A total of 978 patients admitted to our hospital from September 2021 to September 2022 and diagnosed with severe vascular lesions using coronary angiography were enrolled. According to their scores on the Hospital Anxiety and Depression Scale (HADS) and the Center for Epidemiologic Studies Depression Scale at admission, they were divided into two groups and four subgroups: an anxiety group, a non-anxiety group, a depression group, and a non-depression group. The participants' baseline information, clinical characteristics, coronary angiography findings, MACEs, and changes in physical functionality were compared.

Results

There were statistically significant differences between the anxiety and depression groups in marital status, education level, history of diabetes, clinical diagnosis, cardiac troponin T (cTnI), B-type natriuretic peptide (BNP), coronary angiography, and synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Logistic regression analysis showed that gender, education level, diabetes history, cTnI, and SYNTAX score were risk factors for anxiety, while education level, diabetes, and SYNTAX score were risk factors for depression. A Kaplan-Meier survival curve model was used to analyze survival rates in the anxiety and depression groups. Hierarchical regression analyses of anxiety and depression at baseline predicted significant declines in physical functionality.

Conclusions

Social support improved physical functionality and reduced the impact of psychological distress. Psychological state had the greatest long-term prognostic value in patients with CHD.

Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study

AIMS

Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients.

METHODS

CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models.

RESULTS

Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19-4.03, and adjusted HR = 2.70; 95%CI 1.23-5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms.

CONCLUSION

Depressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association.

TRIAL REGISTRATION

This research was registered at https://www.chictr.org.cn . Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan

PURPOSE OF REVIEW

Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women.

RECENT FINDINGS

For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.

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

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