Depression and Cardiac Disease: Epidemiology, Mechanisms, and Diagnosis

Huffman, Jeffery C.; Celano, Christopher M.; Beach, Scott R.; Motiwala, Shweta R.; Januzzi, James L.

doi:10.1155/2013/695925

Cited by 303 publications

(252 citation statements)

References 172 publications

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“…A barrier to maximizing benefit from cardiac rehabilitation is the frequent concurrent presentation of depressive symptoms. Despite these symptoms affecting up to 45% of CAD patients,4 79% of US cardiovascular physicians lack a standard method to screen for them 5. Depressive symptoms are associated with noncompletion of cardiac rehabilitation6 and a 2‐fold increased risk of mortality compared with nondepressed CAD patients 7.…”

Section: Introductionmentioning

confidence: 99%

Novel Phospholipid Signature of Depressive Symptoms in Patients With Coronary Artery Disease

Chan

Suridjan

Mohammad

et al. 2018

JAHA

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BackgroundDepression in patients with coronary artery disease (CAD) is associated with increased cardiovascular morbidity. Given the proinflammatory actions of phospholipids, aberrant phospholipid metabolism may be an etiological mechanism linking CAD and depression. Our primary objective was to identify a phospholipid biomarker panel that characterizes CAD patients with significant depressive symptoms from those without.Methods and ResultsWe performed a targeted lipidomic analysis on CAD patients with significant depressive symptoms (n=37, Center for Epidemiologic Studies Depression score ≥16) and those without (n=49). Phospholipid species were selected using partial least‐square discriminant analysis, and the ability of the resulting model to discriminate between groups was evaluated using receiver operator characteristic curves. Biosignature scores were calculated from this model, and analyses of covariance were performed to compare intergroup differences in biosignature scores, with adjustment for clinical differences between patients. Those with significant depressive symptoms had lower cardiopulmonary fitness, more prevalent history of depression, and a greater number of vascular risk factors. A model of 10 phospholipid species had an area under the curve value of 0.84 (95% confidence interval 0.72‐0.95), sensitivity of 0.73, and specificity of 0.71. This model passed permutation testing (n=1000, P<0.001). Biosignature scores were higher in those with significant depressive symptoms after adjustment for potential confounders (F[1.86]=14.39, P<0.0005).ConclusionsThe present findings support the role of proinflammatory phospholipid species in the presence of depression in CAD patients from the CAROTID trial (Coronary Artery Disease Randomized Omega‐3 Trial in Depression). Future investigations should aim to replicate findings in larger data sets and clarify possible pathophysiological mechanisms.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00981383.

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Section: Introductionmentioning

confidence: 99%

Novel Phospholipid Signature of Depressive Symptoms in Patients With Coronary Artery Disease

Chan

Suridjan

Mohammad

et al. 2018

JAHA

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“…17 Although depression and its impact have been well documented in post-MI patients, much less is known about its significance in patients with chronic stable angina. [18][19][20] Despite the fact that stable angina is the most common manifestation of coronary artery disease, 21,22 studies to date on the relationship between depression and chronic stable angina in the ambulatory setting have been small or restricted to a single center. 15,[23][24][25] Further insight into the prognostic importance of services.…”

Section: Epression Is Prevalent Among Patients With Coronarymentioning

confidence: 99%

Clinical Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina

Szpakowski

Bennell

Qiu

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Depression is prevalent among patients with myocardial infarction and is associated with a worse prognosis.However, little is known about its importance in patients with chronic stable angina. We conducted a retrospective population-based cohort study to determine the occurrence and predictors of developing depression in patients with a new diagnosis of chronic stable angina. In addition, we sought to understand its impact on subsequent clinical outcomes. Methods and Results-Our cohort included patients in Ontario, Canada, with stable angina based on obstructive coronary artery disease found on angiogram. Depression was ascertained by physician billing codes and hospital admissions diagnostic codes. We first developed multivariable Cox proportional hazards models to determine predictors of developing depression. Clinical outcomes of interest included all-cause mortality, admission for myocardial infarction, and subsequent revascularization. Using hierarchical multivariable Cox proportional hazards models with occurrence of depression as a time-varying variable to control for potential immortal time bias, we evaluated the impact of depression on clinical outcomes. Our cohort consisted of 22 917 patients. The occurrence of depression after diagnosis of stable chronic angina was 18.8% over a mean follow-up of 1084 days. Predictors of depression included remote history of depression, female sex, and more symptomatic angina based on Canadian Cardiovascular Society class. Patients who developed depression had a higher risk of death (hazard ratio 1.83, 95% confidence interval 1.62-2.07) and admission for myocardial infarction (hazard ratio 1.36, 95% confidence interval 1.10-1.67) compared with nondepressed patients. Conclusions-Depression is common in patients with chronic stable angina and is associated with increased morbidity and mortality. (Circ Cardiovasc Qual Outcomes. 2016;9:731-739.

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“…The incidence and development of CVD can be brought about by direct physiological effects or indirectly via health behaviours. The psychobiological routes to cardiovascular endpoints can vary according to each PSRF, but collectively include changes in the autonomic nervous system, the endocrine and inflammatory systems, insulin resistance, central adiposity, endothelial and platelet dysfunction [171,172]. Behavioural pathways include unhealthy diet, lower levels of physical activity, excessive alcohol consumption [173,174]; reduced adherence to cardioprotective medications [84], and less engagement with secondary prevention programmes such as smoking cessation and cardiac rehabilitation 86,87].…”

Section: Psychobiological and Behavioural Pathways Linking Psrfs And Cvdmentioning

confidence: 99%

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

2015

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Psychological aspects of cardiac care & rehabilitation: Time to wake up to sleep? Abstract:Psychological and psychosocial factors have long been linked to cardiovascular disease. These psychosocial factors, including low socioeconomic status, social support/isolation, stress and distress, personality and sleep disturbance increase risk of cardiovascular events and negatively impact on quality of life. These factors may have direct effects on cardiovascular disease via immune or neuroendocrine pathways, or more indirect effects, by for example limiting adherence to recommended therapies and cardiac rehabilitation. Most psychosocial risk factors can be assessed relatively easily using standardised tools. Sleep disturbance, in particular, is gaining evidence for its importance, and may be crucial to address. While the management of certain psychosocial risk factors is an ethical requirement for care and improves quality of life, unfortunately there is little evidence that such strategies impact on 'hard' endpoints such as recurrent myocardial infarction. A comprehensive biopsychosocial approach to management of these psychosocial factors is required to maximise the benefits patients derive from cardiac care.

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Depression and Cardiac Disease: Epidemiology, Mechanisms, and Diagnosis

Cited by 303 publications

References 172 publications

Novel Phospholipid Signature of Depressive Symptoms in Patients With Coronary Artery Disease

Novel Phospholipid Signature of Depressive Symptoms in Patients With Coronary Artery Disease

Clinical Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

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