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Zhang Z, Jackson SL, Gillespie C, Merritt R, Yang Q. Depressive Symptoms and Mortality Among US Adults. JAMA Netw Open 2023; 6:e2337011. [PMID: 37812418 PMCID: PMC10562940 DOI: 10.1001/jamanetworkopen.2023.37011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Importance Depression is a common mental health disorder in the US. Depressive symptoms have been associated with increased cardiovascular disease incidence and mortality, but studies have largely focused on narrow population subgroups. Objective To examine the association between depressive symptoms and mortality in a large, diverse, nationally representative sample of US adults, and to examine how lifestyle factors mediate this association. Design, Setting, and Participants This was a prospective cohort study of a nationally representative sample of US adults using National Health and Nutrition Examination Survey 2005 to 2018 data linked with the National Death Index through 2019 for adults aged 20 years and older. Data were analyzed between March 1 and May 26, 2023. Main Outcomes and Measures All-cause, cardiovascular disease, and ischemic heart disease mortality. Depressive symptoms were defined by Patient Health Questionnaire-9 scores and were categorized as none or minimal, mild, and moderate to severe. Secondarily, we assessed degree of mediation by lifestyle factors. Results A total of 23 694 participants were included (unweighted n = 11 862 male [weighted 49.8%]; mean [SE] age, 44.7 [0.24] years). Prevalences of mild and moderate to severe depression were 14.9% and 7.2%, respectively. For all-cause mortality, hazard ratios were 1.35 (95% CI, 1.07-1.72) for mild depressive symptoms vs none and 1.62 (95% CI, 1.24-2.12) for moderate to severe depressive symptoms vs none. The corresponding hazard ratios were 1.49 (95% CI, 1.11-2.00) and 1.79 (95% CI, 1.22-2.62) for cardiovascular disease mortality and 0.96 (95% CI, 0.58-1.60) and 2.21 (95% CI, 1.24-3.91) for ischemic heart disease mortality. The associations were largely consistent across subgroups. Approximately 11.0% to 16.1% of the associations between depression and mortality could be explained by lifestyle factors. Feeling tired or having little energy, poor appetite or overeating, and having little interest in doing things were independently associated with all-cause and cardiovascular disease mortality but not with ischemic heart disease mortality. Conclusions and Relevance In this prospective cohort study of a nationally representative sample of US adults, there was a graded positive association between depressive symptoms and mortality. Public health efforts to improve awareness and treatment of depression and associated risk factors could support a comprehensive, nationwide strategy to reduce the burden of depression.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Merritt
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Verghese D, Muller L, Velamakanni S. Addressing Cardiovascular Risk Across the Arc of a Woman's Life: Sex-Specific Prevention and Treatment. Curr Cardiol Rep 2023; 25:1053-1064. [PMID: 37498450 DOI: 10.1007/s11886-023-01923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women in the United States of America. Despite this, women are underdiagnosed, less often receive preventive care, and are undertreated for CVD compared to men. There has been an increase in sex-specific risk factors and treatments over the past decade; however, sex-specific recommendations have not been included in the guidelines. We aim to highlight recent evidence behind the differential effect of traditional risk factors and underscore sex-specific risk factors with an intention to promote awareness, improve risk stratification, and early implementation of appropriate preventive therapies in women. RECENT FINDINGS Women are prescribed fewer antihypertensives and lipid-lowering agents and receive less cardiovascular care as compared to men. Additionally, pregnancy complications have been associated with increased cardiovascular mortality later in life. Findings from the ARIC study suggest that there is a perception of lower risk of cardiovascular disease in women. The SWEDEHEART study which investigated sex differences in treatment, noted a lower prescription of guideline-directed therapy in women. Women are less likely to be prescribed statin medications by their providers in both primary and secondary prevention as they are considered lower risk than men, while also being more likely to decline and discontinue treatment. A woman's abnormal response to pregnancy may serve as her first physiological stress test which can have implications on her future cardiovascular health. This was supported by the CHAMPs study noting a higher premature cardiovascular risk after maternal complications. Adverse pregnancy outcomes have been associated with a 1.5-4.0 fold increase in future cardiovascular events in multiple studies. In this review, we highlight the differences in traditional risk factors and their impact on women. Furthermore, we address the sex-specific risk factors and pregnancy-associated complications that increase the risk of CVD in women. Adherence to GDMT may have implications on overall mortality in women. An effort to improve early recognition of CVD risk with implementation of aggressive risk factor control and lifestyle modification should be emphasized. Future studies should specifically report on differences in outcomes between males and females. Increased awareness and knowledge on sex-specific risks and prevention are likely to lower the prevalence and improve outcomes of CVD in women.
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Affiliation(s)
- Dhiran Verghese
- Section of Non-Invasive Cardiology, Division of Cardiovascular Medicine, Department of Medicine, NCH Rooney Heart Institute, 34102, Naples, FL, USA
| | - Laura Muller
- Section of Non-Invasive Cardiology, Division of Cardiovascular Medicine, Department of Medicine, NCH Rooney Heart Institute, 34102, Naples, FL, USA
| | - Shona Velamakanni
- Section of Non-Invasive Cardiology, Division of Cardiovascular Medicine, Department of Medicine, NCH Rooney Heart Institute, 34102, Naples, FL, USA.
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De France K, Evans GW, Brody GH, Doan SN. Cost of resilience: Childhood poverty, mental health, and chronic physiological stress. Psychoneuroendocrinology 2022; 144:105872. [PMID: 35879139 DOI: 10.1016/j.psyneuen.2022.105872] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022]
Abstract
Childhood poverty is associated with elevated internalizing symptoms. Nevertheless, some children exposed to poverty evince remarkable resilience, demonstrating lower than expected levels of psychological distress. However, recent work suggests that coping with adversity can lead to undesirable physical health consequences. Specifically, successful adaptation in the context of early adversity, including socioeconomic disadvantage, appears to be associated with elevated chronic physiological stress and ill health. The current study adds to this emerging literature by examining in a longitudinal context whether low levels of internalizing symptoms in the face of childhood poverty is accompanied by elevated chronic physiological stress (allostatic load) during childhood, as well as over time from childhood to adulthood. Results (n = 341; M=9.2 years, 49 % female; 94 % Caucasian) show that childhood poverty was prospectively associated with higher allostatic load during adolescence, controlling for baseline allostatic load. Furthermore, greater duration of childhood poverty led to steeper, more elevated allostatic load trajectories from childhood to adulthood, for youth with lower levels of internalizing symptoms. Efforts to manage adverse sequelae of early adversity likely yield a complex array of benefits and costs.
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Manfrini O, Bugiardini R. Behavioural risk factors and cardiovascular disease: are women at higher risk? Lancet 2022; 400:788-789. [PMID: 36088937 DOI: 10.1016/s0140-6736(22)01736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Olivia Manfrini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna, Italy.
| | - Raffaele Bugiardini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
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Cao H, Zhao H, Shen L. Depression increased risk of coronary heart disease: A meta-analysis of prospective cohort studies. Front Cardiovasc Med 2022; 9:913888. [PMID: 36110417 PMCID: PMC9468274 DOI: 10.3389/fcvm.2022.913888] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Depression, as an independent risk factor, can lead to a substantially increased risk of coronary heart disease (CHD). The overall body of evidence involving depression and CHD is not consistent. Therefore, we performed an update meta-analysis to evaluate the association between depression and the risk of patients with CHD. Methods Studies were identified through a comprehensive literature search of the PubMed, Embase, and the Cochrane Library database from its inception to 28 September 2021 for titles/abstracts with restricted to English language articles. The literature was screened according to the inclusion and exclusion criteria. Along with data extraction, we evaluated the quality of eligible studies using the Newcastle-Ottawa Scale (NOS). The primary outcome was fatal or non-fatal CHD. We calculated relative risk (RR) with 95% confidence intervals (CIs) using a random-effects models. The protocol was registered in the PROSPERO registration (registration number CRD42021271259). Results From 9,151 records, we included 26 prospective cohort studies published from 1998 to 2018, consisting of 402,597 patients. Either in depression-exposured group or non-depression-exposured group, the mean age of all participants ranged from 18 to 99 years. Moreover, the NOS scores of these studies are eventually indicated that the quality of these eligible studies was reliable. In general, the pooled results showed that patients with depression had a higher risk of CHD compared to patients without depression (RR = 1.21, 95% CI: 1.14–1.29). Additionally, the funnel plot appeared to be asymmetry, indicating there existing publication bias for the pooled results between depression and CHD. A sensitivity analysis was used to assess the stability of the relationship between depression and CHD that indicating the results robust (RR = 1.15, 95% CI: 1.09–1.21). Conclusion Depression may increase risk of CHD. Future studies on the share pathogenic mechanisms of both depression and CHD may develop novel therapies.
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Affiliation(s)
- Hongfu Cao
- Gulou Hospital of Traditional Chinese Medicine of Beijing, Beijing, China
| | - Hui Zhao
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Shen
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Li Shen,
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Abstract
IMPORTANCE Longitudinal associations between comorbid depression and anxiety with the accumulation of chronic illnesses are unclear, and questions remain about the contributions associated with each condition in the increasing prevalence of multimorbidity. OBJECTIVE To compare the risk and rate of accumulating chronic conditions in people with depression, anxiety, and comorbid depression and anxiety vs individuals with neither depression nor anxiety. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the Rochester Epidemiology Project medical records-linkage system to identify residents of Olmsted County, Minnesota, from January 1, 2005, to December 31, 2014, with follow-up ending December 31, 2017. The sample was divided into cohorts anchored at birthday ages of 20, 40, and 60 years. Individuals were classified at anchoring birthday age as having depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group), using electronically extracted diagnosis codes from the International Classification of Diseases, Ninth Revision (ICD-9) in the 5 years before each anchoring birthday. Data were analyzed from August 2020 through November 2021. EXPOSURES Depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group). MAIN OUTCOMES AND MEASURES The main outcome was sex-specific risk, calculated as hazard ratios (HRs) and rates of accumulation, calculated as mean annual incidence rates per 100 person-years, of 15 common chronic conditions within each birthday age cohort through the end of study. RESULTS Among the 40 360 individuals included across all 3 age cohorts, 21 516 (53.3%) were women. After balancing cohorts on race, Hispanic ethnicity, education level, body mass index, smoking status, and calendar year at index birthday, the risk of accumulating chronic conditions was significantly increased among women with depression alone (cohort aged 20 years: HR, 1.20 [95% CI, 1.02-1.42]; cohort aged 40 years: HR, 1.20 [95% CI, 1.10-1.31]; cohort aged 60 years: HR, 1.09 [95% CI, 1.02-1.16]) and women with comorbid depression and anxiety (cohort aged 20 years: HR, 1.60 [95% CI, 1.28-1.99]; cohort aged 40 years: HR, 1.41 [95% CI, 1.21-1.65]; cohort aged 60 years: HR, 1.29 [95% CI, 1.15-1.44]) compared with referent women in the same birthday cohorts and in men with comorbid depression and anxiety compared with referent men in the cohort aged 20 years (HR, 1.77 [95% CI, 1.08-2.91]). For women, the rates of accumulation of conditions were significantly higher across birthday cohorts in the comorbid depression and anxiety group compared with the depression alone group (eg, cohort aged 20 years: difference, 1.2 [95% CI, 0.2-2.1] per 100 person-years) and reference group (eg, cohort aged 20 years: difference, 1.7 [95% CI, 0.9-2.6] per 100 person-years). For men, compared with the reference group, the rates of accumulation of conditions were significantly higher in men with comorbid depression and anxiety in the cohort aged 20 years (difference, 1.4 [95% CI, 0.1-2.6] per 100 person-years) and in men with depression in the cohort aged 40 years (difference, 2.0 [95% CI, 0.8-3.2] per 100 person-years). CONCLUSIONS AND RELEVANCE In this cohort study, the risk of accumulating chronic conditions was increased with depression and comorbid depression and anxiety in women across the age span and in younger men with comorbid depression and anxiety. Compared with women without depression or anxiety, there was a more rapid rate of accumulation of chronic conditions in women with depression and anxiety individually and an even higher rate when depression and anxiety cooccurred.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville
| | - Brandon R. Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Sanya Virani
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jennifer L. St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Walter A. Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
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Gottfried S. Women: Diet, Cardiometabolic Health, and Functional Medicine. Phys Med Rehabil Clin N Am 2022; 33:621-645. [DOI: 10.1016/j.pmr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shokeen D, Sokal-Gutierrez K. Association between cardio-metabolic risks and depressive symptoms among US adults (NHANES 2013-2018). J Affect Disord 2022; 299:166-173. [PMID: 34856304 DOI: 10.1016/j.jad.2021.11.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To elucidate the association between cardio-metabolic risk factors and depressive symptoms among US adults. METHODS Data on 9,477 adults ≥ age 18 from the US National Health and Nutrition Examination Survey (NHANES) 2013-2018 were used. Number of cardio-metabolic risk (CMR) factors, from 0 to 5, was based on BMI, blood pressure, fasting blood glucose, and lipid levels. Depressive symptoms by Patient Health Questionnaire (PHQ-9) scores were categorized "no to mild symptoms" (0-9) and "clinically-significant depressive (CSD) symptoms" (10-27). Logistic regression analysis tested associations between CMR factors and CSD symptoms, adjusted for age, gender, education, income, race/ethnicity and smoking status. RESULTS CSD symptoms were significantly associated with low HDL, abdominal obesity, and high triglycerides. Increased numbers of CMR factors were associated with increased odds of CSD symptoms, from 1.45 times for 1 CMR to 2.55 times for 5 CMRs. The cross-sectional nature of the present study has resulted in some limitations like the inability to determine the direction and causality of the effects between depression and CMR. The study data was subject to response bias and recall errors as the participants self-reported the use of medications. CONCLUSIONS In US adults, cardio-metabolic risk factors were associated with clinically-significant depressive symptoms. Public health and clinical programs should include screening for both health issues, intervention for modifiable risk factors, and support for social determinants of health.
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Affiliation(s)
- Deepa Shokeen
- School of Public Health, University of California, Berkeley, CA 94720, United States.
| | - Karen Sokal-Gutierrez
- School of Public Health, University of California, Berkeley, CA 94720, United States
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Harlow SD, Burnett-Bowie SAM, Greendale GA, Avis NE, Reeves AN, Richards TR, Lewis TT. Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health 2022; 8:3. [PMID: 35130984 PMCID: PMC8822825 DOI: 10.1186/s40695-022-00073-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 01/28/2023] Open
Abstract
This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women's Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women's outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women's health - menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function -and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN's design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, School of Public Health, United States, 1415 Washington Heights, Ann Arbor, MI, 48104-2029, USA.
| | - Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gail A Greendale
- Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy Wake Forest School of Medicine, Winston-Salem, USA
| | - Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Thomas R Richards
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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Aljuhani HE, Alshammari GM, Alhadi AN, Alabdulkarem KB, Albader OSM, Baig MB, Yahya MA. Food habits and associated risk factors of depressed patients with cardiovascular disease. PLoS One 2022; 17:e0263519. [PMID: 35113956 PMCID: PMC8812911 DOI: 10.1371/journal.pone.0263519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
The present study was carried out to investigate food habits and associated risk factors of depressed patients with cardiovascular disease in Riyadh city, Saudi Arabia. Depressed and healthy females (n = 30 each) and males (n = 30 each) aged 18–65 years were involved in this study. Sociodemographic, anthropometric proxies, and nutritional status were evaluated. Cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels of respondents’ blood were determined. The respondents were varied according to demographic factors and anthropometric proxies. The majority of depressed males had higher values than healthy ones. The student t-test analysis showed that the average daily intake of fat especially saturated fat, by depressed respondents was higher than that of the healthy ones as well as the dietary requirement intake (DRI). The analysis of respondents’ blood showed that the number of depressed females had higher abnormal HDL-c than males, who were observed to have an abnormal level of cholesterol and triglycerides. The correlation of daily nutrient intake and depression duration, depression severity, and age showed that the nutrients responsible for the extension and severity of depression were intake of food rich in dietary fat. Factors including demographics daily nutrient intake appeared to be associated with depression.
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Bourgi K, Kundu S, Stewart JC, So-Armah K, Freiberg M, Gupta SK. Associations of HIV and Depression with Incident Diabetes Mellitus: Veterans Aging Cohort Study. Clin Infect Dis 2022; 78:ciac085. [PMID: 35134838 PMCID: PMC10874269 DOI: 10.1093/cid/ciac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Persons with HIV (PWH) are at increasingly higher risk for metabolic complications, including diabetes mellitus (DM). Additionally, depression is highly prevalent among PWH and has been associated with increased risk for DM in the general population. However, the association of HIV and depression with incident DM has not been well established. METHODS Using the Veterans Aging Cohort Study (VACS), we selected adults with and without HIV who did not have DM at baseline. Prevalent depression was defined as having a Patient Health Questionnaire-9 (PHQ-9) score of ≥10. Incident DM was identified using validated Kelly's criteria. Basic clinical and demographic characteristics were collected, and cox proportional hazards regression models were run to test the association between depression and incident DM stratified by HIV serostatus. RESULTS A total of 5,722 participants were analyzed, 2,886 (53%) had HIV and 1,124 (20%) had depression at baseline. 1,235 (22%) participants developed incident DM during follow-up, with 26% of HIV-negative participants developing DM compared to 17% of participants with HIV. Depression was significantly associated with increased risk of incident DM among HIV-negative participants (adjusted HR [aHR] = 1.31; p-value 0.003), but not among participants with HIV (aHR 1.09; p-value 0.44). However, among participants with HIV with baseline viral load < 500 copies/mL, we noted a stronger association between depression and incident DM. CONCLUSIONS Incident DM in the VACS cohort is significantly higher for HIV-negative participants compared to veterans with HIV. A significant association between depression and incident DM was noted among HIV-negative participants but not among those with HIV.
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Affiliation(s)
- Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Suman Kundu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesse C Stewart
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kaku So-Armah
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Samir K Gupta
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
OBJECTIVE The pathways underlying the early life adversity and cardiovascular reactivity association remain unclear. The current study examined the role of current depressive symptoms on this relationship. METHODS Mediation analyses were conducted using data from 639 participants drawn from the Midlife Development in the United States 2 Biomarker Project. Responses were derived from the Childhood Trauma Questionnaire and Center for Epidemiologic Studies Depression Scale. Participants had their systolic and diastolic blood pressure (SBP, DBP) and heart rate monitored throughout a standardized stress testing protocol. RESULTS The association between early life adversity and reactivity was mediated by current depressive symptoms; all adversity factors were linked to higher levels of current depressive symptoms, which, in turn, were associated with lower cardiovascular reactivity. For emotional abuse, this was noted for SBP (β = -0.06 [95% confidence interval {CI}, -0.13 to -0.01]) and DBP (β = -0.04 [-0.07 to -0.01]), physical abuse (SBP: β = -0.05 [-0.11 to -0.01]; DBP: β = -0.03 [-0.06 to -0.01]), sexual abuse (SBP: β = -0.04 [-0.09 to -0.01]; DBP: β = -0.02 [-0.05 to -0.01]), emotional neglect (SBP: β = -0.04 [-0.09 to -0.01]; DBP: β = -0.02 [-0.05 to -0.01]), physical neglect (SBP: β = -0.09 [-0.17 to -0.02]; DBP: β = -0.05 [-0.09 to -0.02]), and total Childhood Trauma Questionnaire score (SBP: β = -0.02 [-0.03 to -0.00]; DBP: β = -0.01 [-0.02 to -0.00]). CONCLUSIONS The present findings extend research and demonstrate that depression is an underlying mechanism linking early life adversity and blunted cardiovascular reactivity.
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Affiliation(s)
- Tracey M Keogh
- From the Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory (Keogh, Howard, Gallagher), and Health Research Institute (Keogh, Howard, Gallagher), University of Limerick, Castletroy, Limerick, Ireland
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Sharma T, Padala PR, Mehta JL. Loneliness and Social Isolation: Determinants of Cardiovascular Outcomes. Curr Cardiol Rev 2021; 17:e051121190873. [PMID: 33511946 PMCID: PMC8950500 DOI: 10.2174/1573403x17666210129101845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/30/2022] Open
Abstract
One in three Americans report experiencing loneliness in everyday life, a number that has grown exponentially over the last few decades. As we respond to the SARS-COV2 pandemic with quarantine and social distancing, social isolation and feelings of loneliness are increasing among people of all ages. This presents as an opportune time to recognize the public health impact of these important psychosocial determinants. Loneliness and social isolation are associated with a higher incidence of CVD, higher healthcare utilization and worse outcomes even after controlling for conventional risk factors of CVD. In this review, we discuss loneliness and social isolation as determinants of cardiovascular outcomes, the pathophysiology of this association, and its implications in clinical practice. We discuss some of the shortcomings in the assessment of loneliness and social isolation while identifying the most commonly used rating scales for the same. Finally, we suggest modifications to interventions for loneliness and social isolation during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Jawahar L. Mehta
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Tel: 501-296-1426, E-mail:
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Al Sharie S, Araydah M, Al-Azzam S, Karasneh R, Hammoudeh AJ. The participation of Arab women in randomised clinical trials for cardiovascular diseases. Int J Clin Pract 2021; 75:e14612. [PMID: 34235821 DOI: 10.1111/ijcp.14612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Women's enrolment in randomised clinical trials (RCTs) raises the attention of medical personnel and evidence-based medicine researchers to achieve the highest possible quality and transparency of conducted studies. This study aims to demonstrate various patterns and relationships of women's enrolment in cardiovascular RCTs conducted in Arab countries. MATERIALS AND METHODS Three databases (PubMed, Web of Science and Scopus) were accessed and searched for randomised clinical trials investigating cardiovascular diseases in Arab countries. Studies were screened, data were extracted and risk of bias of included studies was assessed independently by two sets of authors. The female to male ratio and the participation prevalence ratio (PPR) were calculated for each trial and the association of them with different variables were analysed. RESULTS AND DISCUSSION Of the 9071 patients enrolled in the 71 included RCTs, 38.02% were women. Various factors such as age of participants, publication year, therapeutic class, clinical indication, prevention type, and location of trial showed a significant association with the level of women enrolment in cardiovascular randomised clinical trials in Arab countries (P-value < .05). The median female to male ratio of all the trials was 0.55. The median female: male ratio varied by clinical indications (2.33 for valvular heart diseases vs 0.5 for stroke), intervention type (0.46 for surgical procedures vs 0.52 for drugs), prevention type (0.79 for secondary prevention, 0.74 for primary prevention and 0.52 for tertiary prevention), sample size (0.48 for Q1 vs 0.85 for Q2) and by age groups (0.98 for ages ≤50 years old vs 0.47 for 56-60 years old). Women were overrepresented in valvular heart disease trials (PPR = 1.37), and underrepresented in coronary artery disease, stroke and atrial fibrillation trials (PPR = 0.6, 0.63, and 0.71, respectively). CONCLUSION As a result of the huge importance of RCTs in the medical field, and to reduce biases arising from inaccurate representation of different study populations, women's enrolment in Arab cardiovascular trials should be pre-planned and based on the percentage of women among the studied disease population.
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Affiliation(s)
| | | | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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15
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Kolhe JV, Chhipa AS, Butani S, Chavda V, Patel SS. PCOS and Depression: Common Links and Potential Targets. Reprod Sci 2021. [PMID: 34642910 DOI: 10.1007/s43032-021-00765-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
PCOS or polycystic ovary syndrome is a common endocrine disorder that occurs during the reproductive age in females. It manifests in the form of a wide range of symptoms including (but not limited to) hirsutism, amenorrhea, oligomenorrhea, obesity, acne vulgaris, infertility, alopecia, and insulin resistance. The incidence of depression in PCOS population is increasing as compared to the general population. Increased depression in PCOS significantly alters the quality of life (QOL) of affected females. Also, self-esteem is found to be low in both depression and PCOS. The loss in self-esteem in such patients can be largely attributed to the associated factors including (but not limited to) obesity, acne, androgenic alopecia, and hirsutism. The reason behind the occurrence of depression in PCOS remains elusive to date. Literature suggests that there is an overlap of clinical symptoms between depression and PCOS. As the symptoms overlap, there is a possibility of common associations between depression, PCOS, and PCOS-associated abnormalities including insulin resistance (IR), obesity, CVD, and androgen excess. Studies demonstrate that depression is an inflammatory disorder marked with increased levels of inflammatory markers. On the other hand, PCOS is also regarded as a pro-inflammatory state that is characterized by increased levels of pro-inflammatory markers. Thus, there is a possibility of an inflammatory relationship existing between depression and PCOS. It is also possible that the inflammatory markers in PCOS can cross the blood-brain barrier (BBB) leading to the development of depression. Through the present review, we have attempted to shed light on common associations/shared links between depression and PCOS with respect to the levels of cortisol, androgen, vitamin D, neurotransmitters, monoaminoxidase (MAO), and insulin-like growth factor-1 (IGF-1). Tracking down common associations between depression and PCOS will help find potential drug therapies and improve the QOL of females with depression in PCOS.
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Mulvagh SL, Mullen KA, Nerenberg KA, Kirkham AA, Green CR, Dhukai AR, Grewal J, Hardy M, Harvey PJ, Ahmed SB, Hart D, Levinsson AL, Parry M, Foulds HJ, Pacheco C, Dumanski SM, Smith G, Norris CM. The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman. CJC Open 2021; 4:115-132. [PMID: 35198930 PMCID: PMC8843896 DOI: 10.1016/j.cjco.2021.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/13/2021] [Indexed: 02/09/2023] Open
Abstract
Women have unique sex- and gender-related risk factors for cardiovascular disease (CVD) that can present or evolve over their lifespan. Pregnancy-associated conditions, polycystic ovarian syndrome, and menopause can increase a woman’s risk of CVD. Women are at greater risk for autoimmune rheumatic disorders, which play a role in the predisposition and pathogenesis of CVD. The influence of traditional CVD risk factors (eg, smoking, hypertension, diabetes, obesity, physical inactivity, depression, anxiety, and family history) is greater in women than men. Finally, there are sex differences in the response to treatments for CVD risk and comorbid disease processes. In this Atlas chapter we review sex- and gender-unique CVD risk factors that can occur across a woman’s lifespan, with the aim to reduce knowledge gaps and guide the development of optimal strategies for awareness and treatment.
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Smirnova MD, Svirida ON, Fofanova TV, Blankova ZN, Yarovaya EB, Ageev FT, Boytsov SA. Subclinical depression and anxiety as an additional risk factor for cardiovascular events in low- and moderate-risk patients: data from 10-year follow-up. Cardiovasc Ther Prev 2021. [DOI: 10.15829/1728-8800-2021-2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the contribution of anxiety (A) and depression (D) to the increased risk of cardiovascular events (CVEs) in patients with Systematic Coronary Risk Evaluation (SCORE) <5% according to 10-year follow-up.Material and methods. The work included 190 patients with SCORErisk <5%, examined in 2009-2010. In addition to the standard examination, a questionnaire was carried out using Hospital Anxiety and Depression Scale (HADS). In 2019, we contacted participants by telephone to identify CVEs over the past time: death from cardiovascular diseases (CVDs), acute myocardial infarction (MI), unstable angina, stroke, revascularization. The response was 86,3%.Results. CVEs occurred in 17 (10,2%) patients and included following outcomes: 3 deaths from CVDs, 6 acute MIs, 4 cases of unstable angina, 12 revascularizations. Patients with and without CVEs differed only in the depression level — 7 (5; 7) vs 5.0 (4; 5) points (p=0,0001). HADS-D score >6 increased the probability of CVEs — odds ratio (OR) 2,9 (1,1-7,7). In individuals with HADS-D score >6 and/or HADS-A score >7, the probability of CVEs increased — OR 4,9 (1,4-17,9). A combination of impaired two or more parameters of the lipid profile, systolic blood pressure >130 mm Hg and HADS-D score >6 and/or HADS-A score >7 increased the risk of CVE — OR 7,3 (2,48-21,36).Conclusion. Depression, including subclinical depression, is associated with an increased risk of CVEs in patients with a SCORE risk <5%.
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Affiliation(s)
| | | | | | | | | | - F. T. Ageev
- National Medical Research Center of Cardiology
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18
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Wu S, Zhou Y, Xuan Z, Xiong L, Ge X, Ye J, Liu Y, Yuan L, Xu Y, Ding G, Xiao A, Guo J, Yu L. Repeated use of SSRIs potentially associated with an increase on serum CK and CK-MB in patients with major depressive disorder: a retrospective study. Sci Rep 2021; 11:13365. [PMID: 34183728 PMCID: PMC8239012 DOI: 10.1038/s41598-021-92807-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022] Open
Abstract
There is a large amount of evidence that selective serotonin reuptake inhibitors (SSRIs) are related to cardiovascular toxicity, which has aroused concern regarding their safety. However, few studies have evaluated the effects of SSRIs on cardiac injury biomarkers, such as creatine kinase (CK) and creatine kinase isoenzyme (CK-MB). The purpose of our study was to determine whether SSRIs elevated CK and CK-MB levels of prior medicated depressive patients (PMDP) compared to first-episode drug-naïve depressive patients (FDDPs). We performed an observational and retrospective study involving 128 patients with major depressive disorder. Patients who had never used any type of antidepressant were designated FDDP; patients who had used only one type of SSRI but were not treated after a recent relapse were designated PMDP. Serum CK and CK-MB levels were measured before and after using SSRIs for a period of time. The duration of current treatment in the FDDP and PMDP groups was 16.200 ± 16.726 weeks and 15.618 ± 16.902 weeks, respectively. After SSRI treatment, levels of serum CK in the PMDP group were significantly higher than in the FDDP group. Univariate ANCOVA results revealed that PMDP was 22.313 times more likely to elevate CK (OR 22.313, 95% CI 9.605-35.022) and 2.615 times more likely to elevate CK-MB (OR 2.615, 95% CI 1.287-3.943) than FDDP. Multivariate ANCOVA revealed an interaction between the group and sex of CK and CK-MB. Further pairwise analysis of the interaction results showed that in female patients, the mean difference (MD) of CK and CK-MB in PMDP was significantly greater than that in FDDP (MD = 33.410, P = 0.000, 95% CI 15.935-50.886; MD = 4.613, P = 0.000, 95% CI 2.846-6.381). Our findings suggest that patients, especially females, who had previously used SSRI antidepressants were more likely to have elevated CK and CK-MB, indicators of myocardial muscle injury. Use of SSRIs should not be assumed to be completely safe and without any cardiovascular risks.
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Affiliation(s)
- Shengwei Wu
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Yufang Zhou
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Zhengzheng Xuan
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, 510120, China
| | - Linghui Xiong
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Xinyu Ge
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Junrong Ye
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Yun Liu
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Lexin Yuan
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Yan Xu
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Guoan Ding
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China
| | - Aixiang Xiao
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China.
| | - Jianxiong Guo
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China.
| | - Lin Yu
- Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, Guangdong, China.
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
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Jeon-Slaughter H, Chen X, Tsai S, Ramanan B, Ebrahimi R. Developing an Internally Validated Veterans Affairs Women Cardiovascular Disease Risk Score Using Veterans Affairs National Electronic Health Records. J Am Heart Assoc 2021; 10:e019217. [PMID: 33619994 PMCID: PMC8174271 DOI: 10.1161/jaha.120.019217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The current American College of Cardiology/American Heart Association women cardiovascular disease (CVD) risk score suboptimally estimates CVD risk for young and minority women in the military. The current study developed an internally validated CVD risk score for women military service members and veterans using the Veterans Affairs (VA) national electronic health records data. Methods and Results The study cohort included 69 574 White, Black, and Hispanic women service members and veterans aged 30 to 79 years in 2007 treated in the VA Health Care System between January 1, 2007 and December 31, 2017 (henceforth, VA women). Stratified by race and ethnicity, the new VA women CVD risk model estimated risk coefficients and 10‐year CVD risk using a time‐variant covariate Cox model. Harrell C‐statistics, calibration plots, and net classification index were used to assess accuracy and prognostic performance of the new VA women CVD risk model. The new internally validated VA women CVD risk score performed better in predicting VA women 10‐year atherosclerosis cardiovascular disease risk than the pooled cohort American College of Cardiology/American Heart Association risk score in both accuracy (White Harrell C‐statistics, 70% versus 61%; Black, 68% versus 63%) and prognostic performance (White net classification index, 0.31; 95% CI, 0.26–0.33; Black net classification index, 0.06; 95% CI, 0.03–0.09). Conclusions The proposed VA women CVD risk score improves accuracy of the existing American College of Cardiology/American Heart Association CVD risk assessment tool in predicting long‐term CVD risk for VA women, particularly in young and racial/ethnic minority women.
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Affiliation(s)
- Haekyung Jeon-Slaughter
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Xiaofei Chen
- Veterans Affairs North Texas Health Care System Dallas TX.,Southern Methodist University Dallas TX
| | - Shirling Tsai
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Ramin Ebrahimi
- Veterans Affairs Greater Los Angeles Health Care System Los Angeles CA.,Department of Medicine University of California at Los Angeles CA
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20
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Platt JM, Bates L, Jager J, McLaughlin KA, Keyes KM. Is the US Gender Gap in Depression Changing Over Time? A Meta-Regression. Am J Epidemiol 2021; 190:1190-1206. [PMID: 33423055 PMCID: PMC8484777 DOI: 10.1093/aje/kwab002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
The depression gap refers to higher rates of depression among women than men. Change in the depression gap over time might elucidate social causes of this disparity-such as unequal college attendance or employment status. We conducted a meta-regression analysis to estimate variation in the depression gap over time by age, accounting for potential sources of variation between studies. Electronic databases and bibliographies were searched for English-language studies from January 1980 through October 2019; 144 independent estimates from US-representative samples met selection criteria (n = 813,189). The depression gap was summarized as prevalence ratios among studies using diagnostic instruments and as standardized mean differences among symptom-based studies. Primary study measures were baseline study year (range, 1982-2017) and age (age groups ranging, in years, from 10-59 and 60 or older). Compared with respondents aged ≥60 years, depression prevalence was greater among respondents aged 10-19 (prevalence ratio = 1.26, 95% confidence interval: 1.02, 1.56). Over time, the depression gap did not change among adults, but it increased among adolescents (age-by-time interaction prevalence ratio = 1.05, 95% confidence interval: 1.01, 1.08). Results were similar for symptom-based studies. The present study finds no evidence of a change in the depression gender gap for US adults; however, the gap increased among adolescents. Greater attention to factors driving this widening disparity in adolescent depression is needed.
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Affiliation(s)
- Jonathan M Platt
- Correspondence to Dr. Jonathan M. Platt, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032 (e-mail: )
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21
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Goldstein BI, Korczak DJ. Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk. Can J Cardiol 2020; 36:1394-1405. [DOI: 10.1016/j.cjca.2020.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
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22
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Smaardijk VR, Lodder P, Kop WJ, van Gennep B, Maas AHEM, Mommersteeg PMC. Sex- and Gender-Stratified Risks of Psychological Factors for Incident Ischemic Heart Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 8:e010859. [PMID: 31030598 PMCID: PMC6512085 DOI: 10.1161/jaha.118.010859] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Psychological factors are associated with an increased risk of developing ischemic heart disease (IHD). Women more often report psychological factors, and sex and gender differences are present in IHD. In this meta‐analysis we examine the risks of psychological factors for IHD incidence in women and men. We hypothesize that a broad range of psychological factors are related to a higher risk for incident IHD, with a higher risk for women. Methods and Results PubMed, EMBASE, and PsycINFO were searched for studies assessing the risk between psychological factors and incident IHD. Psychological factors included depression, anxiety or panic disorder, social support, hostility, anger, personality (type D), type A behavior pattern, posttraumatic stress disorder, and psychological distress. In the primary analyses, 62 studies (77 separate reports) that included 2 145 679 women and 3 119 879 men and reported confounder‐adjusted hazard ratios or relative risks were included. Pooled effect confounder‐adjusted estimates from random‐effects models showed that psychological factors (all combined) were associated with incident IHD in women (hazard ratio: 1.22; 95% CI, 1.14–1.30) and men (hazard ratio: 1.25; 95% CI, 1.19–1.31). No sex and gender differences were found for these pooled effect estimates (P=0.547). Conclusions Psychological factors are associated with incident IHD in both women and men, but no significant differences were observed between women and men. IHD is predominantly being studied as obstructive coronary artery disease, which is more prevalent in men. Data are needed on psychological predictors and other manifestations of IHD such as coronary microvascular disease, which is more common in women.
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Affiliation(s)
- Veerle R Smaardijk
- 1 Department of Medical and Clinical Psychology Center of Research on Psychology in Somatic diseases (CoRPS) Tilburg University Tilburg The Netherlands
| | - Paul Lodder
- 1 Department of Medical and Clinical Psychology Center of Research on Psychology in Somatic diseases (CoRPS) Tilburg University Tilburg The Netherlands.,2 Department of Methodology and Statistics Tilburg University Tilburg The Netherlands
| | - Willem J Kop
- 1 Department of Medical and Clinical Psychology Center of Research on Psychology in Somatic diseases (CoRPS) Tilburg University Tilburg The Netherlands
| | - Bente van Gennep
- 1 Department of Medical and Clinical Psychology Center of Research on Psychology in Somatic diseases (CoRPS) Tilburg University Tilburg The Netherlands
| | - Angela H E M Maas
- 3 Department of Cardiology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Paula M C Mommersteeg
- 1 Department of Medical and Clinical Psychology Center of Research on Psychology in Somatic diseases (CoRPS) Tilburg University Tilburg The Netherlands
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Lin M, Huang H, Yao J, Liang J, Li L, Lin W, Lin L, Hong F, Lu J, Bi Y, Wang W, Wen J, Chen G. Association between Depression and Renal Hyperfiltration in a General Chinese Population. Kidney Blood Press Res 2020; 44:1441-1452. [PMID: 31734665 DOI: 10.1159/000503922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depression is prevalent in patients with all stages of CKD and is associated with adverse outcome. Abnormally elevated GFR, or hyperfiltration, may play a crucial role in the initiation and progression of CKD. However, the association between depression and hyperfiltration is not known. The aim of this study is to investigate the relationship between depression and hyperfiltration. METHODS This was an observational cross-sectional study. A total of 3,716 volunteers (1,303 males and 2,413 females) aged 40-75 years without CKD from a community in China were included for the study. Depressive symptoms and the presence of a minor or major depressive episode were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Diagnostic and Statistical Manual of Mental Disorders (4th edition)-based structured interview, respectively. RESULTS The mean age of the participants in the present study was 53.8 ± 9.0 years. 115 participants had clinically relevant depression, and 122 participants had a minor or major depressive episode. In a multivariable logistic regression analysis adjusted for potential confounders, the association between clinically relevant depression and renal hyperfiltration remained significant in men but not in women. As compared with men without depression (PHQ <5) or depressive episodes, those with clinically relevant depression (PHQ ≥10) had a significantly higher risk of renal hyperfiltration. The fully adjusted OR (95% CI) was 4.81 (1.62-14.30, p = 0.005), those with a major depressive episode had a higher risk of renal hyperfiltration (OR 7.45; 95% CI 2.04-27.21, p = 0.002). CONCLUSION Depressive symptoms and major depressive episodes are associated with renal hyperfiltration in middle-aged and elderly Chinese men without CKD. Future studies are needed to verify and clarify the role of depression in the development of abnormally high eGFR and CKD.
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Affiliation(s)
- Miao Lin
- Department of Nephrology, Fujian Shengli Clinical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Huibin Huang
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jin Yao
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jixing Liang
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Liantao Li
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Wei Lin
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Lixiang Lin
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Fuyuan Hong
- Department of Nephrology, Fujian Shengli Clinical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jieli Lu
- Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junping Wen
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Gang Chen
- Department of Endocrinology, Fujian Shengli Clinical College, Fujian Academy of Medical Sciences, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China,
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Zhao J, Hua S, Wang W, Fan W, Tang W, Zhang Y, Zhang C. Identification of TNFA influencing MDD risk and clinical features in Han Chinese. Cytokine 2020; 129:155030. [DOI: 10.1016/j.cyto.2020.155030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 01/07/2023]
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Welsh J, Korda RJ, Banks E, Strazdins L, Joshy G, Butterworth P. Identifying long-term psychological distress from single measures: evidence from a nationally representative longitudinal survey of the Australian population. BMC Med Res Methodol 2020; 20:55. [PMID: 32138694 PMCID: PMC7059354 DOI: 10.1186/s12874-020-00938-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single time-point assessments of psychological distress are often used to indicate chronic mental health problems, but the validity of this approach is unclear. The aims of this study were to investigate how a single assessment of distress relates to longer-term assessment and quantify misclassification from using single measures to indicate chronic distress. METHODS Data came from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative study of Australian adults. Psychological distress, measured with the Kessler10 and categorised into low (scores:10- < 12), mild (12- < 16), moderate (16- < 22) and high (22-50), has been assessed in the Survey biennially since wave 7. Among respondents who were aged ≥25 years and participated in all waves in which distress was measured, we describe agreement in distress categories, and using a mixed linear model adjusting for age and sex we estimate change in scores, over a two-, four-, six- and eight-year follow-up period. We applied weights, benchmarked to the Australian population, to all analyses. RESULTS Two-years following initial assessment, proportions within identical categories of distress were 66.0% for low, 54.5% for mild, 44.0% for moderate and 50.3% for high, while 94.1% of those with low distress initially had low/mild distress and 81.4% with high distress initially had moderate/high distress. These patterns did not change materially as follow-up time increased. Over the full eight-year period, 77.3% of individuals with high distress initially reported high distress on ≥1 follow-up occasion. Age-and sex- adjusted change in K10 scores over a two-year period was 1.1, 0.5, - 0.7 and - 4.9 for low, mild, moderate and high distress, respectively, and also did not change materially as follow-up time increased. CONCLUSION In the absence of repeated measures, single assessments are useful proxies for chronic distress. Our estimates could be used in bias analyses to quantify the magnitude of the bias resulting from use of single assessments to indicate chronic distress.
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Affiliation(s)
- J Welsh
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.
| | - R J Korda
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - E Banks
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.,The Sax Institute, Ultimo, Australia
| | - L Strazdins
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - G Joshy
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - P Butterworth
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.,Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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Polanka BM, Berntson J, Vrany EA, Stewart JC. Are Cardiovascular Risk Factors Stronger Predictors of Incident Cardiovascular Disease in U.S. Adults With Versus Without a History of Clinical Depression? Ann Behav Med 2019; 52:1036-1045. [PMID: 30418524 DOI: 10.1093/abm/kay007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Several mechanisms underlying the depression-to-cardiovascular disease (CVD) relationship have been proposed; however, few studies have examined whether depression promotes CVD through potentiating traditional cardiovascular risk factors. Purpose To test the combined influence of three cardiovascular risk factors and lifetime depressive disorder on incident CVD in a large, diverse, and nationally representative sample of U.S. adults. Methods Respondents were 26,840 adults without baseline CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Lifetime depressive disorder, tobacco use, hypertension, and incident CVD were determined from structured interviews, and body mass index (BMI) was computed from self-reported height and weight. Results Logistic regression models predicting incident CVD (1,046 cases) revealed evidence of moderation, as the interactions between lifetime depressive disorder and current tobacco use (p = .002), hypertension (p < .001), and BMI (p = .031) were significant. The Former Tobacco Use × Lifetime Depressive Disorder interaction was not significant (p = .85). In models stratified by lifetime depressive disorder, current tobacco use (OR = 1.78, 95% CI = 1.36-2.32, p < .001 vs. OR = 1.41, 95% CI = 1.24-1.60, p < .001), hypertension (OR = 2.46, 95% CI = 1.98-3.07, p < .001 vs. OR = 1.39, 95% CI = 1.28-1.51, p < .001), and BMI (OR = 1.10, 95% CI = 1.01-1.20, p = .031 vs. OR = 1.03, 95% CI = 0.99-1.07, p = .16) were stronger predictors of incident CVD in adults with versus without a lifetime depressive disorder. Conclusions Our findings suggest that amplifying the atherogenic effects of traditional cardiovascular risk factors may be yet another candidate mechanism that helps to explain the excess CVD risk of people with depression.
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Affiliation(s)
- Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Jessica Berntson
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Elizabeth A Vrany
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Mewton L, Reppermund S, Crawford J, Bunce D, Wen W, Sachdev P. Cross-sectional and prospective inter-relationships between depressive symptoms, vascular disease and cognition in older adults. Psychol Med 2019; 49:2168-2176. [PMID: 30370877 DOI: 10.1017/s0033291718002994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It has been proposed that vascular disease is the mechanism linking depression and cognition, but prospective studies have not supported this hypothesis. This study aims to investigate the inter-relationships between depressive symptoms, cognition and cerebrovascular disease using a well-characterised prospective cohort. METHOD Data came from waves 1 (2005-2007) and 2 (2007-2009) of the Sydney Memory and Ageing Study (n = 462; mean age = 78.3 years). RESULTS At wave 1, there was an association between depressive symptoms and white matter hyperintensity (WMH) volume [b = 0.016, t(414) = 2.34, p = 0.020]. Both depressive symptoms [b = -0.058, t(413) = -2.64, p = 0.009] and WMH volume [b = -0.011, t(413) = -3.77, p < 0.001], but not stroke/transient ischaemic attack (TIA) [b = -0.328, t(413) = -1.90, p = 0.058], were independently associated with lower cognition. Prospectively, cerebrovascular disease was not found to predict increasing depressive symptoms [stroke/TIA: b = -0.349, t(374.7) = -0.76, p = 0.448; WMH volume: b = 0.007, t(376.3) = 0.875, p = 0.382]. Depressive symptoms predicted increasing WMH severity [b = 0.012, t(265.9) = -3.291, p = 0.001], but not incident stroke/TIA (odds ratio = 0.995; CI 0.949-1.043; p = 0.820). When examined in separate models, depressive symptoms [b = -0.027, t(373.5) = -2.16, p = 0.032] and a history of stroke/TIA [b = -0.460, t(361.2) = -4.45, p < 0.001], but not WMH volume [b = 0.001, t(362.3) = -0.520, p = 0.603], predicted declines in cognition. When investigated in a combined model, a history of stroke/TIA remained a predictor of cognitive decline [b = -0.443, t(360.6) = -4.28, p < 0.001], whilst depressive symptoms did not [b = -0.012, t(359.7) = -0.96, p = 0.336]. CONCLUSIONS This study is contrasted with previous prospective studies which indicate that depressive symptoms predict cognitive decline independently of vascular disease. Future research should focus on further exploring the vascular mechanisms underpinning the relationship between depressive symptoms and cognition.
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Affiliation(s)
- Louise Mewton
- Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Developmental Disability Neuropsychiatry, UNSW Medicine, University of New South Wales, Sydney
| | - John Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - David Bunce
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Psychology, University of Leeds, Leeds, UK
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Ellins EA, Shipley MJ, Rees DA, Kemp A, Deanfield JE, Brunner EJ, Halcox JP. Associations of depression-anxiety and dyslipidaemia with subclinical carotid arterial disease: Findings from the Whitehall II Study. Eur J Prev Cardiol 2019; 27:800-807. [PMID: 31529992 DOI: 10.1177/2047487319876230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS There is mixed evidence for an association between depression and/or anxiety and carotid intima-media thickness, and limited information on the related role of dyslipidaemia. Here we report associations between depression and/or anxiety and intima-media thickness in the Whitehall II cohort, considering the moderating effects of sex and dyslipidaemia. METHODS A total of 2822 men and 1112 women (61 ± 6 years) were studied during phase 7 (2002-2004) of the Whitehall II study. Intima-media thickness and lipid levels were assessed, and questionnaires (general health questionnaire and the Centre for Epidemiologic Studies depression scale) were completed. Linear regression was used to explore relationships between depression and/or anxiety and intima-media thickness and the moderating effects of sex and dyslipidaemia. RESULTS A total of 1461 participants were categorised with depression and/or anxiety. The association between depression and/or anxiety and intima-media thickness differed between men and women so analyses were undertaken separately by sex. In men, intima-media thickness was significantly associated with dyslipidaemia (P = 0.002) but not depression and/or anxiety (P = 0.29). In women, both dyslipidaemia and depression and/or anxiety were independently associated with intima-media thickness (P = 0.028 and P = 0.031). The greatest intima-media thickness was in women with both depression and/or anxiety and dyslipidaemia. These results were replicated when the general health questionnaire score was substituted for depression and/or anxiety and non-high-density lipoprotein cholesterol for dyslipidaemia. CONCLUSIONS Depression and/or anxiety is associated with increased intima-media thickness in women but not in men. Dyslipidaemia is associated with intima-media thickness in both men and women. Women with both depression and/or anxiety and dyslipidaemia are potentially at the greatest risk of cardiovascular disease.
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Affiliation(s)
| | - Martin J Shipley
- Institute of Epidemiology and Health Care, University College London, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, UK
| | - Andrew Kemp
- College of Human and Health Sciences, Swansea University, UK
| | - John E Deanfield
- UCL Institute of Cardiovascular Science, University College London, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, University College London, UK
| | - Julian P Halcox
- Institute of Life Science, Swansea University Medical School, UK
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O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
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Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
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Maffei S, Guiducci L, Cugusi L, Cadeddu C, Deidda M, Gallina S, Sciomer S, Gastaldelli A, Kaski JC. Women-specific predictors of cardiovascular disease risk - new paradigms. Int J Cardiol 2019; 286:190-197. [DOI: 10.1016/j.ijcard.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
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Hazuda HP, Gaussoin SA, Wing RR, Yanovski SZ, Johnson KC, Coday M, Wadden TA, Horton ES, Van Dorsten B, Knowler WC. Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes. Diabetes Care 2019; 42:910-918. [PMID: 30833373 PMCID: PMC6489104 DOI: 10.2337/dc18-0575] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score <10 or ≥10). ADM use was coded from participants' prescription medications. Four composite CVD outcomes were defined in the study protocol. Sex-stratified Cox proportional hazards models were adjusted for a range of baseline covariates. RESULTS Depression symptoms were only significantly associated with a composite secondary outcome comprising CVD death, nonfatal myocardial infarction, nonfatal stroke, hospitalized angina, congestive heart failure, peripheral vascular disease, coronary artery bypass graft, and carotid endarterectomy. Significant sex interactions were observed for BDI score and BDI score ≥10. BDI score was significantly associated with higher probability of this composite outcome in men but was not associated with the outcome in women. BDI score ≥10 was positively associated with this composite outcome in men but was negatively associated in women. Exploratory analysis identified a significant BDI ≥10 × ADM use interaction for this composite outcome that differed in men versus women. Men with both BDI score ≥10 and ADM use compared with those with neither had 60% higher probability of the outcome, whereas women with both compared with those with neither had 50% lower probability. CONCLUSIONS Sex differences in the association of depression symptoms and ADM use with incident CVD warrant further investigation.
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Affiliation(s)
- Helen P Hazuda
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Rena R Wing
- The Miriam Hospital/Brown Medical School, Providence, RI
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Mace Coday
- The University of Tennessee, Memphis, TN
| | | | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Hildreth KL, Ozemek C, Kohrt WM, Blatchford PJ, Moreau KL. Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life. Menopause 2018; 25:1011-1019. [PMID: 29634636 PMCID: PMC6103796 DOI: 10.1097/gme.0000000000001112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages. METHODS Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses. RESULTS Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = -0.27 to -0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = -0.08, -0.03, P = 0.35). CONCLUSIONS Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
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Affiliation(s)
- Kerry L. Hildreth
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
| | - Cemal Ozemek
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago
| | - Wendy M. Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
| | - Patrick J. Blatchford
- Colorado Biostatistical Consortium, Colorado School of Public Health, University of Colorado Denver
| | - Kerrie L. Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine
- Eastern Colorado VA Geriatric Research, Education and Clinical Center
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Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality among women worldwide. The pathophysiological basis of cardiovascular health among men and women is not identical. This leads to variable cardiovascular responses to stimulus and presentation of cardiovascular disease symptoms, both of which can have a direct effect on treatment outcomes. Traditionally, the enrollment of women in clinical trials has been minimal, resulting in a lack of gender-specific analysis of clinical trial data and, therefore, the absence of concrete risk factor assessment among women. However, scientific progress in the past decade has identified a spectrum of risk factors for cardiovascular diseases that may be specific to women. These risk factors, which may include menopause, hypertensive disease of pregnancy, and depression, confer additional risk in women besides the traditional risk factors. The current state of knowledge and awareness about these risk factors is suboptimal at this time. Therefore, although the treatment of cardiovascular diseases is similar in both genders, appropriate risk stratification may be limited in women compared to men. The purpose of this review is to describe the recent trends in identifying female-specific risk factors for cardiovascular diseases, their utility in risk stratification, and current pharmacological options for women with regard to cardiovascular disease prevention.
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Affiliation(s)
- Anum Saeed
- BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | | | - Vijay Nambi
- MICHAEL E. DEBAKEY VA MEDICAL CENTER, HOUSTON, TEXAS.,BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
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Gorczyca AM, Sperry JC, Chomistek AK. The Relationship of Objective Physical Activity with Traditional and Nontraditional Cardiovascular Disease Risk Factors in Women. Curr Cardiovasc Risk Rep 2018; 12. [DOI: 10.1007/s12170-018-0586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim MH, Lee KM, Kim SJ, Kim SY, Park JS, Cho YR, Park K, Park TH, Kim YD, Serebruany V. Impact of marital status on outcomes following ST-segment elevation myocardial infarction. Cardiovascular Revascularization Medicine 2018; 19:237-40. [DOI: 10.1016/j.carrev.2017.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/13/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022]
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Vander Weg MW, Coday M, Stockton MB, McClanahan B, Relyea G, Read MC, Wilson N, Connelly S, Richey P, Johnson KC, Ward KD. Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial. Contemp Clin Trials Commun 2018; 9:50-59. [PMID: 29333504 PMCID: PMC5760189 DOI: 10.1016/j.conctc.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 11/24/2022] Open
Abstract
Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.
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Affiliation(s)
- Mark W. Vander Weg
- Iowa City VA Health Care Center, Center for Comprehensive Access & Delivery Research & Evaluation (CADRE) and Veterans Rural Health Resource Center – Central Region, Iowa City, IA, USA
- Departments of Internal Medicine and Psychological and Brain Sciences and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - George Relyea
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Mary C. Read
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Nancy Wilson
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | | | - Phyllis Richey
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kenneth D. Ward
- School of Public Health, The University of Memphis, Memphis, TN, USA
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Yang L, Korhonen K, Moustgaard H, Silventoinen K, Martikainen P. Pre-existing depression predicts survival in cardiovascular disease and cancer. J Epidemiol Community Health 2018; 72:617-622. [DOI: 10.1136/jech-2017-210206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/23/2018] [Accepted: 02/09/2018] [Indexed: 12/18/2022]
Abstract
BackgroundPrevious studies have found depression to be negatively associated with the prognosis of both cardiovascular disease (CVD) and cancer, but this may partly reflect reverse causality. We limited the possibility of reverse causality by measuring depression before the first diagnosis of CVD or cancer.MethodsWe used an 11% longitudinal random sample of the Finnish population aged 25 years or older who are residents of Finland for at least 1 year between 1987 and 2007, with an 80% oversample of those who died during this period. Those who had their first incidence of coronary heart disease (CHD) (n=107 966), stroke (n=68 685) or cancer (n=113 754) between 1998 and 2012 were followed up for cause-specific mortality from the date of diagnosis until the end of 2012. Depression was defined as having antidepressant purchases two to three calendar years before the incidence. Logistic and Cox regression models were used to examine short-term and long-term mortality by depression status.ResultsLong-term mortality after diagnosis was 1.34 (95% CI 1.25 to 1.44) for CHD, 1.26 (95% CI 1.15 to 1.37) for stroke and 1.10 (95% CI 1.04 to 1.16) for cancer in those who had used antidepressants in two consecutive calendar years as compared with those with no purchases. Short-term mortality from CHD was elevated among persons with depression (OR=1.30; 95% CI 1.06 to 1.61), but no association was found for stroke.ConclusionPre-existing depression is associated with a worse prognosis of CHD, stroke and cancer. More attention in the healthcare system is needed for patients with chronic diseases who have a history of depression.
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Jang HY, Song YK, Kim JH, Kim MG, Han N, Lee HY, Kim IW, Oh JM. Impact of depression on change in coronary heart disease risk status: the Korean Genome and Epidemiology Study (KoGES). Ther Clin Risk Manag 2018; 14:121-128. [PMID: 29391804 PMCID: PMC5768190 DOI: 10.2147/tcrm.s149501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this study was to evaluate the association between depression and change in coronary heart disease (CHD) risk status by an analysis of examination data in the general Korean population. Patients and methods We examined 1,851 men and 1,689 women (aged 43–73 years) for the Korean Genome and Epidemiology Study Ansan between 2005 and 2012. The estimated CHD risk score of participants was calculated using the Framingham CHD risk score in baseline and after 8-year follow-up period. Among them, population with low Framingham CHD risk score (<10%) in baseline (n=1,582) was used for further analyses. The low Framingham CHD risk score participants were assigned to one of two groups based on the Beck depression inventory (BDI) score: no depression (BDI <10) and depression (BDI ≥10). Multivariate logistic regression was performed to test whether depression was associated with participants’ status change to intermediate or high CHD risk score (≥10%) in men and women, respectively, after 8-year follow-up period. Results Women with depression showed significant higher rates of changing to intermediate or high CHD risk score status when compared with women without depression even after adjusting for age, systolic blood pressure, high-density lipoprotein, and smoking (adjusted odds ratio [OR], 1.54; 95% CI, 1.08–2.03). However, depression was not associated with intermediate or high CHD risk score status in men (adjusted OR, 1.38; 95% CI, 0.95–1.82). Conclusion This general population-based cohort study provides evidence that depression can affect the risk of changing CHD risk score status in women.
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Affiliation(s)
- Ha Young Jang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Yun-Kyoung Song
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Jae Hyun Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Myeong Gyu Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Wha Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul
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Tayefi M, Shafiee M, Kazemi-Bajestani SMR, Esmaeili H, Darroudi S, Khakpouri S, Mohammadi M, Ghaneifar Z, Azarpajouh MR, Moohebati M, Heidari-Bakavoli A, Parizadeh MR, Nematy M, Safarian M, Ebrahimi M, Ferns GA, Mokhber N, Ghayour-Mobarhan M. Depression and anxiety both associate with serum level of hs-CRP: A gender-stratified analysis in a population-based study. Psychoneuroendocrinology 2017; 81:63-69. [PMID: 28419913 DOI: 10.1016/j.psyneuen.2017.02.035] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depression and anxiety are two important mood disorders that are frequently associated with chronic diseases such as cardiovascular diseases (CVDs). Hyper-inflammation is related to both CVDs and psychological conditions such as depression and anxiety. Therefore, inflammation may partially explain the relationship between depression and cardiovascular disease. OBJECTIVE The objective of this study was to perform a gender-stratified examination of the association between symptoms of depression/anxiety disorders and serum hs-CRP and inflammation linked conditions in a large Iranian population. METHODS Symptoms of depression and anxiety disorders and serum hs-CRP levels were measured in 9759 participants (40% males and 60% females) aged 35-65 years, enrolled in a population-based cohort (MASHAD) study in north-eastern Iran. Symptoms of depression and anxiety were evaluated with Beck Depression and Anxiety Inventories. According to the scores of depression and anxiety, individuals were categorized into four groups of no or minimal, low, moderate and severe categories. RESULTS The median serum hs-CRP concentration increased with increasing severity of depression and anxiety disorders. Male participants with severe depression had significantly higher levels of hs-CRP (p<0.001); however, this relationship was less marked among women (p=0.04). Subjects with severe anxiety also had significantly higher levels of hs-CRP (p<0.001). Moreover, women with severe depression and anxiety had higher BMI. There was also a positive association between current smoking habit and depression/anxiety disorders. CONCLUSION Depression and anxiety disorders are associated with elevated levels of hs-CRP, particularly among men. Also, there is a significant positive association between depression/anxiety disorders and inflammation linked conditions such as smoking and obesity; however, in the case of obesity this association is only present in women.
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Affiliation(s)
- Maryam Tayefi
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Shafiee
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Mohammad Reza Kazemi-Bajestani
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Oncology, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Habibolah Esmaeili
- Department of Biostatistics & Epidemiology, School of Health, Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Darroudi
- Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Khakpouri
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mohammadi
- Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Ghaneifar
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpajouh
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Heidari-Bakavoli
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Parizadeh
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Ebrahimi
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK
| | - Naghmeh Mokhber
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull 2017; 143:783-822. [PMID: 28447828 DOI: 10.1037/bul0000102] [Citation(s) in RCA: 1076] [Impact Index Per Article: 153.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record
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Affiliation(s)
- Rachel H Salk
- Department of Psychology, University of Wisconsin-Madison
| | - Janet S Hyde
- Department of Psychology, University of Wisconsin-Madison
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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Dong YH, Bykov K, Choudhry NK, Donneyong MM, Huybrechts KF, Levin R, Schneeweiss S, Gagne JJ. Clinical Outcomes of Concomitant Use of Warfarin and Selective Serotonin Reuptake Inhibitors: A Multidatabase Observational Cohort Study. J Clin Psychopharmacol 2017; 37:200-9. [PMID: 28129313 DOI: 10.1097/JCP.0000000000000658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients treated with warfarin are often coprescribed selective serotonin reuptake inhibitors (SSRIs) for coexisting depression. Some SSRIs are potent CYP2C9 inhibitors that may increase warfarin plasma concentrations and the risk of bleeding. We aimed to examine the effect of the putative CYP2C9-mediated warfarin-SSRI interaction on clinical outcomes. METHODS We conducted an observational cohort study among warfarin initiators who had a subsequent SSRI prescription in 5 US claims databases. Patients were followed for up to 180 days as long as they were exposed to both warfarin and their index SSRI groups. Cox regression models were used to estimate hazard ratios and 95% confidence intervals for bleeding events, ischemic or thromboembolic events, and mortality comparing patients treated with SSRIs that are potent CYP2C9 inhibitors (fluoxetine, fluvoxamine) with those treated with other SSRIs after propensity score matching. FINDINGS The eligible cohort comprised 52,129 patients. Hazard ratios were 1.14 (95% confidence interval [CI], 0.94-1.38) for bleeding events, 1.03 (95% CI, 0.87-1.21) for ischemic or thromboembolic events, and 0.90 (95% CI, 0.72-1.14) for mortality. Results were consistent across individual component outcomes, different warfarin stabilization periods, and subgroup analyses. CONCLUSIONS Patients concomitantly treated with warfarin and SSRIs that are potent CYP2C9 inhibitors had comparable rates of bleeding events, ischemic or thromboembolic events, and mortality as did patients cotreated with warfarin and other SSRIs, although small but potentially meaningful effects on bleeding cannot be completely excluded. SSRI inhibition of CYP2C9 does not appear to affect major safety or effectiveness outcomes of warfarin treatment in clinical practice, where patients may be closely monitored.
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Ma W, Shen D, Liu J, Pan J, Yu L, Shi W, Deng L, Zhu L, Yang F, Liu J, Cai W, Yang J, Luo Y, Cui H, Liu S. Statin Function as an Anti-inflammation Therapy for Depression in Patients With Coronary Artery Disease by Downregulating Interleukin-1β. J Cardiovasc Pharmacol 2016; 67:129-35. [PMID: 26398164 DOI: 10.1097/FJC.0000000000000323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It is well known that inflammation contributes to the development of coronary artery disease (CAD) and depressive symptoms. Previous studies have shown that long-term application of statin reduces the occurrence of depression in patients with CAD. However, the mechanism remains unclear. We hypothesized that inflammation contributes to depression in patients with CAD and statin function as an anti-inflammation therapy for those depressive patients. Patients with confirmed CAD hospitalized in the Department of Cardiology of Tongji Hospital in Shanghai, China, were enrolled. Depression was identified as none (ND), mild (MiD), moderate (MoD), or severe (SD) on the basis of scores of the patient health questionnaire with 9 items. Inflammatory factors in peripheral blood were measured using a chemiluminescence immunoassay and Bio-plex. Luciferase expression level was detected using the Dual-Luciferase Reporter Assay System for IL-1β or NF-κB expression by transfection in human umbilical vein endothelial cells, and patient serum was added. Data obtained from 217 patients with CAD were analyzed. The IL-1β level of CAD with SD was 14.70, which was significantly higher than that of CAD with ND 7.52, MiD 7.73, or MoD 8.63. Luciferase reporter gene analysis showed that IL-1β or NF-κB expression level was upregulated by the serum of CAD and depression patients. After the addition of atorvastatin, IL-1β or NF-κB luciferase reporter expression level decreased. It suggested that depression in patients with CAD is associated with inflammation. Statin may function as an anti-inflammation therapy for depression in patients with CAD by downregulation of IL-1β.
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Liu X, Li J, Zheng P, Zhao X, Zhou C, Hu C, Hou X, Wang H, Xie P, Xu G. Plasma lipidomics reveals potential lipid markers of major depressive disorder. Anal Bioanal Chem 2016; 408:6497-507. [PMID: 27457104 DOI: 10.1007/s00216-016-9768-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
Major depressive disorder (MDD) is a grave debilitating mental disease with a high incidence and severely impairs quality of life. Therefore, its physiopathological basis study and diagnostic biomarker discovery are extremely valuable. In this study, a non-targeted lipidomics strategy using ultra performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) was performed to reveal differential lipids between MDD (n = 60) and healthy controls (HCs, n = 60). Validation of changed lipid species was performed in an independent batch including 75 MDD and 52 HC using the same lipidomic method. Pronouncedly changed lipid species in MDD were discovered, which mainly were lysophosphatidylcholine (LPC), lysophosphatidylethanolamine (LPE), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI), 1-O-alkyl-2-acyl-PE (PE O), 1-O-alkyl-2-acyl-PC (PC O), sphingomyelin (SM), diacylglycerol (DG), and triacylglycerol (TG). Among these lipid species, LPC, LPE, PC, PE, PI, TG, etc. remarkably increased in MDD and showed pronounced positive relationships with depression severity, while 1-O-alkyl-2-acyl-PE and SM with odd summed carbon number significantly decreased in MDD and demonstrated negative relationships with depression severity. A combinational lipid panel including LPE 20:4, PC 34:1, PI 40:4, SM 39:1, 2, and TG 44:2 was defined as potential diagnostic biomarker with a good sensitivity and specificity for distinguishing MDD from HCs. Our study brings insights into lipid metabolism disorder in MDD and provides a specific potential biomarker for MDD diagnose.
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Affiliation(s)
- Xinyu Liu
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jia Li
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Peng Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, 400016, China
| | - Xinjie Zhao
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China
| | - Chanjuan Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, 400016, China
| | - Chunxiu Hu
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China
| | - Xiaoli Hou
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China
| | - Haiyang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, 400016, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. .,Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, 400016, China.
| | - Guowang Xu
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian, Liaoning, 116023, China.
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Affiliation(s)
- Simone Reppermund
- Department of Developmental Disability and Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Australia, Sydney NSW 2052, Australia.
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Abstract
Depression and anxiety are major public health problems and have been shown to be associated with increased risk for cardiovascular disease. The prevalence and incidence of depression and anxiety are lower in those who are regularly active. Regular physical activity has also been shown to reduce symptoms of depression and anxiety in those who already suffer from these disorders. Depression and anxiety may increase the risk for cardiovascular disease by a number of mechanisms, including hypertension and reduced vascular function, autonomic nervous system dysfunction, and increased platelet activity and aggregation. Regular physical activity has been demonstrated to lower blood pressure and improve nitric oxide— mediated vascular function, increase heart rate variability and baroreflex sensitivity, increase fibrinolysis, and, possibly, decrease platelet activity. Little or no work has been done to determine the optimal amount or intensity of exercise to prevent or reduce the symptoms of depression and anxiety. Based on the limited data available, a physical activity routine consistent with the 1996 Surgeon General's Report on Physical Activity and Health is appropriate—specifically, at least 30 minutes of moderate-intensity activity on most days, if not every day, of the week. Little evidence supports a dose-response relation between physical activity and depression or any of the physiological mechanisms discussed here. This is not to say that there is no such relationship but, rather, that well-controlled studies are lacking. Studies on anxiety, especially, are lacking. This includes the link with cardiovascular disease, physiological mechanisms, and the effects of regular physical activity.
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Affiliation(s)
- Robert F. Zoeller
- Department of Exercise Science & Health Promotion, Florida Atlantic University, Davie, Florida,
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Quiros-Roldan E, Raffetti E, Focà E, Brianese N, Ferraresi A, Paraninfo G, Pezzoli MC, Bonito A, Magoni M, Scarcella C, Castelli F. Incidence of cardiovascular events in HIV-positive patients compared to general population over the last decade: a population-based study from 2000 to 2012. AIDS Care 2016; 28:1551-1558. [PMID: 27321070 DOI: 10.1080/09540121.2016.1198750] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiovascular diseases are currently a main cause of death among people living with HIV. This population-based study aimed to investigate the incidence of cardiovascular events (CVEs) in HIV-positive people and factors associated with CVEs. We performed a retrospective cohort study of the HIV-infected patients residing in the Local Health Authority of Brescia, northern Italy, from 2000 to 2012. Incidence of CVEs events in HIV-positive patients was compared with that expected in general population living in the same area, computing standardized incidence ratios (SIRs). CVEs-associated risk factors were assessed using Cox regression analysis and competing risk model of death. About 3766 HIV-infected patients were included in the study. Over the 12-year-period, we recorded 134 CVEs: 83 (61.9%) acute myocardial infarctions (CVE type-1), and 51 (38.1%) strokes (CVE type-2). A twofold increased risk (SIR = 2.02) of CVEs was found in HIV-infected patients compared to the general population. Notably, within male patients: for CVE type-1, SIR = 1.89, for CVE type-2 SIR = 2.25; within female patients: for CVE type-1, SIR = 2.91, for CVE type-2 SIR = 2.07. Age >45 years, male gender, diabetes, and total blood cholesterol >200 mg/dl were significantly associated with CVEs incidence (for all, p < .05). These results were confirmed using the competing risk model. Our cohort study confirmed the higher incidence of CVEs in HIV-positive patients, and put emphasis on the importance of traditional cardiovascular risk factors. Overall CVE risk in HIV-positive patients was twice as high as CVE risk in general population. We found a peculiar gender distribution, with a relative risk for CVE type-1 higher in HIV-positive females, and a higher CVE type-2 risk in male patients. More studies are needed in order to support these findings and to further highlight possible gender differences in the risk of developing CVEs in HIV-positive patients.
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Affiliation(s)
- Eugenia Quiros-Roldan
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Elena Raffetti
- b Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health , University of Brescia , Brescia , Italy
| | - Emanuele Focà
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Nigritella Brianese
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Alice Ferraresi
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Giuseppe Paraninfo
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Maria Chiara Pezzoli
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Andrea Bonito
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Michele Magoni
- c Local Health Agency of the Brescia Province , Brescia , Italy
| | | | - Francesco Castelli
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
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Muka T, Oliver-Williams C, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, Kavousi M, Franco OH. Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0157417. [PMID: 27315068 PMCID: PMC4912069 DOI: 10.1371/journal.pone.0157417] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/31/2016] [Indexed: 01/11/2023] Open
Abstract
Importance Vasomotor symptoms (hot flushes and night sweats) and other symptoms, including depression, anxiety and panic attacks, are commonly experienced by menopausal women and have been associated with an unfavourable cardiovascular risk profile. Objective To investigate whether presence of menopausal symptoms is associated with the development of cardiovascular disease (CVD). Methods Five electronic databases (Medline, EMBASE and Web of Science) were search until February 17th, 2015 to identify relevant studies. Observational cohort studies or randomised intervention studies were eligible for inclusion if they followed participants prospectively (at least 1 year of follow-up), and reported relevant estimates on the association of any vasomotor symptoms, or other menopausal symptoms, with risk of CVD, coronary heart disease (CHD), or stroke in perimenopausal, menopausal, or postmenopausal women. Data were extracted by two independent reviewers using a pre-designed data collection form. Separate pooled relative risks (RRs) for age and non-established cardiovascular risk factors (e.g., education, ethnicity) adjusted data and for established cardiovascular risk factors and potential mediators-adjusted data (e.g., smoking, body mass index, and hypertension) were calculated. Results Out of 9,987 initially identified references, ten studies were selected, including 213,976 women with a total of 10,037 cardiovascular disease outcomes. The age and non-established cardiovascular risk factors adjusted RRs) [95% confidence intervals] for development of CHD, Stroke and CVD comparing women with and without any menopausal symptoms were 1.34 [1.13–1.58], 1.30 [0.99–1.70], 1.48 [1.21–1.80] respectively, and the corresponding RRs adjusted for cardiovascular risk factors and potential mediators were 1.18 [1.03–1.35], 1.08 [0.89–1.32], 1.29 [0.98–1.71]. However, these analyses were limited by potential unmeasured confounding and the small number of studies on this topic. Conclusion Presence of vasomotor symptoms and other menopausal symptoms are generally associated with an increased risk of cardiovascular disease, which is mainly explained by cardiovascular risk factors.
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Affiliation(s)
- Taulant Muka
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Clare Oliver-Williams
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Veronica Colpani
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Setor Kunutsor
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Susmita Chowdhury
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Rajiv Chowdhury
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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