Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences

Abstract

Background The association of depressive symptoms with health status in peripheral artery disease (PAD) is understudied. No reports of differential impact on women have been described. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories) registry enrolled 1243 patients from vascular specialty clinics with new or worsening PAD symptoms. Depressive symptoms were assessed at baseline and 3 months using the 8‐Item Patient Health Questionnaire (score ≥10 indicating clinically relevant depressive symptoms). Disease‐specific and generic health status were measured by Peripheral Artery Questionnaire and EQ‐5D Visual Analogue Scale at baseline and 3, 6, and 12 months. An adjusted general linear model for repeated measures was constructed for baseline and 3‐, 6‐, and 12‐month health status outcomes by depressive symptoms at baseline. Differences by sex were tested with interaction effects. The mean age was 67.6±9.4 years with 38% (n=470) women. More women than men (21.1% versus 12.9%; P <0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all P <0.0001). Results were similar for EQ‐5D Visual Analogue Scale scores. The magnitude in 1‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in 1‐year Peripheral Artery Questionnaire summary scores. Conclusions Women with PAD have a high burden of depressive symptoms. Depressive symptoms were associated with a strikingly worse disease‐specific health status recovery path over the year following PAD diagnosis in men and women. Developing and testing interventions to address depressive symptoms in PAD are urgently needed. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01419080.

Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis

“…Brevetti et al 34 Al-Zoubi et al 45 Kumakura et al 39 Choi et al 46 Dang et al 36 Sartipy et al 50 Jelani et al 47 McDermott et al 32 Lo et al 48 Peters et al 49 Behrendt et al 33 Haine et al 52 Collins et al Finally, four studies reported atypical leg symptoms. 32,35,42,47 Women more often had atypical leg symptoms (22.8% vs. 19.8%) OR 1.18 (95% CI 0.96 e 1.45), and the heterogeneity was low I 2 ¼ 36%. The quality of evidence was considered very low, downgraded due to inconsistency, indirectness, and imprecision (Fig.…”

“…Separate subgroup analyses were performed by grouping the studies according to the proportion of subjects with Heterogeneity: Tau Gardner et al 37 Brevetti et al 51 Murabito et al 40 Brevetti et al 34 Al-Zoubi et al 45 Kumakura et al 39 Vliegenthart et al 44 Choi et al 46 Sigvant et al 41 Smolderen et al 42 Dang et al 36 Sartipy et al 50 Jelani et al 47 McDermott et al 32 Tekin et al 43 Lo et al 48 Peters et al 49 Behrendt et al 33 Krishnan et al 38 Haine et al 52 Collins et al 35 Al-Zoubi et al 45 Kumakura et al 39 Vliegenthart et al 44 Choi et al 46 Sartipy et al 50 Jelani et al 47 McDermott et al 32 Peters et al 49 Haine et al 52 Collins et al…”

Sex-Specific Differences in Cardiovascular Risk, Risk Factors and Risk Management in the Peripheral Arterial Disease Population

“…Psychological morbidity is an important, modifiable, and often overlooked risk factor for CVD, and is associated with an increased risk of PAD [55,68]. A single-centre study in America demonstrated that, following PAD revascularisation procedures, patients with depression were at greater risk of death or major adverse cardiovascular events (adjusted HR 2.05, 95% CI 1.16-2.86), and progression of contralateral disease (HR 2.20, 95% CI 1.22-3.96) [21].…”

“…Associations between depression and death following coronary artery bypass surgery have been demonstrated, and the presence of mental-stress-induced ischaemia amongst the stable CAD population is associated with an increased risk of cardiovascular death or MI (HR 2.0, 95% CI 1.1-3.7) [69][70][71]. This increased CVD risk may arise secondary to changes in microvascular tone, blood pressure, endothelial dysfunction and heightened platelet aggregation, which have been observed in depression and anxiety [68,[71][72][73][74]. In a study of 444 patients in Dutch vascular outpatient clinics, approximately 40% of women aged <65 years, with a diagnosis of PAD of 6 months duration, demonstrated significant depressive symptoms.…”

Importância do destreinamento físico sobre a capacidade funcional em indivíduos com doença arterial obstrutiva crônica periférica: estudo transversal piloto

“…Walking capacity was measured using the 6-minute walk test (6MWT) by a group of specialists, following American Thoracic Society guidelines. 14 During the 6MWT, we used a visual analog scale (VAS) 15,16 to measure pain in the lower limbs, and also administered the Borg subjective exertion scale. 17 The test was conducted in a 30m corridor and patients were instructed to walk as far as possible in 6 minutes.…”