scholarly journals Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial

2011 ◽  
Vol 42 (1) ◽  
pp. 51-60 ◽  
Author(s):  
S. Bekke-Hansen ◽  
M. Trockel ◽  
M. M. Burg ◽  
C. Barr Taylor
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trial ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Cardiovascular Mortality ◽  
Bonferroni Correction ◽  
Symptom Dimensions ◽  
Symptom Dimension ◽  
Increased Risk ◽  
Co Morbidity

BackgroundDepression following myocardial infarction (MI) independently increases risk for early cardiac morbidity and mortality. Studies suggest that somatic, but not cognitive, depressive symptoms are responsible for the increased risk. However, the effects of somatic depressive symptoms at follow-up, after sufficient time has elapsed to allow for physical recovery from the initial infarction, are not known. Our aim was to examine the relationship between cognitive and somatic depressive symptom dimensions at baseline and 12 months post-MI and subsequent mortality and cardiovascular morbidity.MethodPatients were 2442 depressed and/or socially isolated men and women with acute MI included in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. We used principal components analysis (PCA) of the Beck Depression Inventory (BDI) items to derive subscales measuring cognitive and somatic depressive symptom dimensions, and Cox regression with Bonferroni correction for multiple testing to examine the contribution of these dimensions to all-cause mortality, cardiovascular mortality, and first recurrent non-fatal MI.ResultsAfter adjusting for medical co-morbidity and Bonferroni correction, the somatic depressive symptom dimension assessed proximately following MI did not significantly predict any endpoints. At 12 months post-MI, however, this dimension independently predicted subsequent all-cause [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.13–1.81] and cardiovascular mortality (HR 1.60, 95% CI 1.17–2.18). No significant associations were found between the cognitive depressive symptom dimension and any endpoints after Bonferroni correction.ConclusionsSomatic symptoms of depression at 12 months post-MI in patients at increased psychosocial risk predicted subsequent mortality. Psychosocial interventions aimed at improving cardiac prognosis may be enhanced by targeting somatic depressive symptoms, with particular attention to somatic symptom severity at 12 months post-MI.

scholarly journals Adverse Outcome Prediction of Iron Deficiency in Patients with Acute Coronary Syndrome

Biomolecules ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. 60 ◽  
Author(s):  
Tanja Zeller ◽  
Christoph Waldeyer ◽  
Francisco Ojeda ◽  
Renate Schnabel ◽  
Sarina Schäfer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Iron Deficiency ◽  
Cardiovascular Mortality ◽  
Adverse Outcome ◽  
Smoking Status ◽  
Coronary Syndrome ◽  
Iron Deficient ◽  
Increased Risk

Acute myocardial infarction remains a leading cause of morbidity and mortality. While iron deficient heart failure patients are at increased risk of future cardiovascular events and see improvement with intravenous supplementation, the clinical relevance of iron deficiency in acute coronary syndrome remains unclear. We aimed to evaluate the prognostic value of iron deficiency in the acute coronary syndrome (ACS). Levels of ferritin, iron, and transferrin were measured at baseline in 836 patients with ACS. A total of 29.1% was categorized as iron deficient. The prevalence of iron deficiency was clearly higher in women (42.8%), and in patients with anemia (42.5%). During a median follow-up of 4.0 years, 111 subjects (13.3%) experienced non-fatal myocardial infarction (MI) and cardiovascular mortality as combined endpoint. Iron deficiency strongly predicted non-fatal MI and cardiovascular mortality with a hazard ratio (HR) of 1.52 (95% confidence interval (CI) 1.03-2.26; p = 0.037) adjusted for age, sex, hypertension, smoking status, diabetes, hyperlipidemia, body-mass-index (BMI) This association remained significant (HR 1.73 (95% CI 1.07–2.81; p = 0.026)) after an additional adjustment for surrogates of cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide, NT-proBNP), for the size of myocardial necrosis (troponin), and for anemia (hemoglobin). Survival analyses for cardiovascular mortality and MI provided further evidence for the prognostic relevance of iron deficiency (HR 1.50 (95% CI 1.02–2.20)). Our data showed that iron deficiency is strongly associated with adverse outcome in acute coronary syndrome.

scholarly journals Telephone-based Behavioral Activation with Mental Imagery for depression: a pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic

2021 ◽  
Author(s):  
Johnny Pellas ◽  
Fritz Renner ◽  
Julie Lin Ji ◽  
Mattias Damberg
Keyword(s):  
Older Adults ◽  
Clinical Trial ◽  
Depressive Symptoms ◽  
Randomized Clinical Trial ◽  
Mental Imagery ◽  
Treatment Condition ◽  
Behavioral Activation ◽  
Mental Health Problems ◽  
Older Individuals ◽  
Increased Risk

ObjectivesTo shield vulnerable persons, particularly the eldery, during the Covid-19 pandemic governments around the world have adviced to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the covid-19-pandemic.MethodsIn this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a Behavioral Activation with Mental Imagery treatment condition, or an Attention-Assessment control condition delivered over the telephone over a four week period.ResultsDepressive symptoms decreased more in the treatment condition compared to the control condition. At post treatment 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed.ConclusionsThis pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.

Long-term prognosis of de novo atrial fibrillation during acute myocardial infarction: the impact of anti-thrombotic treatment strategies

2020 ◽  
Author(s):  
Felix Hofer ◽  
Niema Kazem ◽  
Andreas Hammer ◽  
Feras El-Hamid ◽  
Lorenz Koller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Mortality ◽  
Patient Population ◽  
De Novo ◽  
Treatment Strategies ◽  
Increased Risk ◽  
The Impact

Abstract Aims While the prognosis of patients presenting with de novo atrial fibrillation (AF) during the acute phase of myocardial infarction has been controversially discussed, it seems intuitive that affected individuals have an increased risk for both thrombo-embolic events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of de novo AF and associated anti-thrombotic treatment strategies on the patient outcome from a long-term perspective. Methods and results Patients presenting with acute myocardial infarction, treated at the Medical University of Vienna, were enrolled within a clinical registry and screened for the development of de novo AF. After discharge, participants were followed prospectively over a median time of 8.6 years. Primary study endpoint was defined as cardiovascular mortality. Out of 1372 enrolled individuals 149 (10.9%) developed de novo AF during the acute phase of acute myocardial infarction. After a median follow-up time of 8.6 years, a total of 418 (30.5%) died due to cardiovascular causes, including 93 (62.4%) in the de novo AF subgroup. We found that de novo AF was significantly associated with long-term cardiovascular mortality with an adjusted HR of 1.45 (95% CI 1.19–2.57; P < 0.001). While patients with de novo AF were less likely to receive a triple anti-thrombotic therapy as compared to patients with pre-existing AF at time of discharge, this therapeutic approach showed a strong and inverse association with mortality in de novo AF, with an adj. HR of 0.86 (95% CI 0.45–0.92; P = 0.012). Conclusion De novo AF was independently associated with a poor prognosis with a 67% increased risk of long-term cardiovascular mortality. Intensified anti-thrombotic treatment in this high-risk patient population might be considered.

scholarly journals Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis

2014 ◽  
Vol 44 (13) ◽  
pp. 2689-2703 ◽  
Author(s):  
R. de Miranda Azevedo ◽  
A. M. Roest ◽  
P. W. Hoen ◽  
P. de Jonge
Keyword(s):  
Heart Disease ◽  
Depressive Symptoms ◽  
Adverse Outcomes ◽  
Future Research ◽  
Symptom Dimensions ◽  
Symptoms Of Depression ◽  
Cardiovascular Prognosis ◽  
Affective Symptoms ◽  
Increased Risk ◽  
Prospective Longitudinal

BackgroundSeveral prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the association of cognitive/affective and somatic/affective symptoms of depression with cardiovascular prognosis in patients with heart disease using a meta-analytic perspective.MethodA systematic search was performed in PubMed, EMBASE and PsycInfo. Thirteen prospective studies on symptom dimensions of depression and cardiovascular prognosis fulfilled the inclusion criteria, providing data on a total of 11 128 subjects. The risk estimates for each dimension of depressive symptoms, demographic and methodological variables were extracted from the included articles.ResultsIn least-adjusted analyses, both the somatic/affective [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.19–1.41, p < 0.001] and cognitive/affective (HR 1.07, 95% CI 1.00–1.15, p = 0.05) dimensions of depressive symptoms were associated with cardiovascular prognosis. In fully adjusted analyses, somatic/affective symptoms were significantly associated with adverse prognosis (HR 1.19, 95% CI 1.10–1.29, p < 0.001) but cognitive/affective symptoms were not (HR 1.04, 95% CI 0.97–1.12, p = 0.25). An increase of one standard deviation (±1 s.d.) in the scores of the somatic/affective dimension was associated with a 32% increased risk of adverse outcomes (HR 1.32, 95% CI 1.17–1.48, p < 0.001).ConclusionsSomatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.

Uricemia in the acute phase of myocardial infarction and its relation to long-term mortality risk

2021 ◽  
Author(s):  
Milan Hromadka ◽  
Jan Opatrny ◽  
Roman Miklik ◽  
David Suchy ◽  
Jan Bruthans ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Uric Acid ◽  
Acute Phase ◽  
Risk Ratio ◽  
Cardiovascular Mortality ◽  
Mortality Rates ◽  
Cardiovascular Risk Reduction ◽  
Hazard Risk ◽  
Increased Risk

Aim: Although uric acid has antioxidant effects, hyperuricemia has been established as an indicator of increased cardiovascular mortality in various patient populations. Treatment of asymptomatic hyperuricemia in patients with acute myocardial infarction (MI) is not routinely recommended, and the efficacy of such treatment in terms of cardiovascular risk reduction remains doubtful. Materials & methods: In a prospective cohort study, we followed 5196 patients admitted for a MI between 2006 and 2018. We assessed the relationship between baseline uricemia and the incidence of all-cause death and cardiovascular mortality and the effect of long-term allopurinol treatment. Hyperuricemia was defined as serum uric acid >450 μmol/l in men and >360 μmol/l in women. Results: In the entire cohort, the 1-year all-cause and cardiovascular mortality rates were 8 and 7.4%, and the 5-year rates were 18.3 and 15.3%, respectively. Using a fully adjusted model, hyperuricemia was associated with a 70% increased risk of both all-cause death and cardiovascular mortality at 1 year, and the negative prognostic value of hyperuricemia persisted over the 5-year follow-up (for all-cause death, hazard risk ratio = 1.45 [95% CI: 1.23–1.70] and for cardiovascular mortality, hazard risk ratio = 1.52 [95% CI: 1.28–1.80], respectively). Treatment of asymptomatic hyperuricemia with allopurinol did not affect mortality rates. Conclusion: Hyperuricemia detected in patients during the acute phase of an MI appears to be independently associated with an increased risk of subsequent fatal cardiovascular events. However, hyperuricemia treatment with low-dose allopurinol did not prove beneficial for these patients.

Abstract MP86: Depressive Symptoms are Associated with Mental Stress-Induced Myocardial Ischemia After Acute Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jingkai Wei ◽  
Pratik Pimple ◽  
Amit J Shah ◽  
Cherie Rooks ◽  
Douglas Bremner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Mental Stress ◽  
Perfusion Defect ◽  
Difference Score ◽  
Emission Computed Tomography ◽  
Pharmacological Stress

Objectives: Previous studies indicated that depressed mood may act as a trigger of acute coronary syndromes, although the mechanisms are not clear. We aimed to examine the association between depression and mental stress-induced myocardial ischemia in young survivors of a myocardial infarction (MI), and the possible differential association of somatic and cognitive depressive symptom dimensions. Hypothesis: Higher levels of depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress. Methods: We studied 98 patients (49 women and 49 men) age 38-59 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging with [99mTc]sestamibi single-proton emission computed tomography at rest, after mental stress (speech task), and after exercise treadmill stress. If unable to exercise (N=16), patients underwent pharmacological stress test with regadenoson. Myocardial perfusion defect scores were obtained with observer-independent software. A summed difference score, the difference between stress and rest perfusion defect scores, was used to quantify myocardial perfusion defects due to ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms. Two separate scores of somatic and cognitive depressive symptoms were calculated. Multivariate linear regression models were used in the analysis. Results: There was a significant and graded positive association between depressive symptoms and summed difference score with mental stress. After adjustment for demographical and lifestyle factors, severity of coronary heart disease and medications, each incremental depressive symptom was associated with 0.14 higher ischemia perfusion defect score [β=0.14, 95% CI: (0.03, 0.24), p=0.01]. When somatic and cognitive depressive symptoms were examined separately, both somatic symptoms [β=0.17, 95% CI: (0.04, 0.30), p=0.01] and cognitive symptoms [β=0.31, 95% CI: (0.07, 0.56), p=0.01] showed a significant association with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress. Conclusion: Among young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with exercise/pharmacological stress. Future studies should explore whether mental stress-induced ischemia explains the poorer prognosis associated with depressive symptoms in post-MI patients.

scholarly journals Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis

2009 ◽  
Vol 40 (5) ◽  
pp. 807-814 ◽  
Author(s):  
E. J. Martens ◽  
P. W. Hoen ◽  
M. Mittelhaeuser ◽  
P. de Jonge ◽  
J. Denollet
Keyword(s):  
Myocardial Infarction ◽  
Depressive Symptom ◽  
Disease Severity ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Symptom Dimensions ◽  
Cardiovascular Prognosis ◽  
Affective Symptoms

BackgroundIndividual symptoms of post-myocardial infarction (MI) depression may be differentially associated with cardiac prognosis, in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms. These findings hold important implications for treatment but need to be replicated before conclusions regarding treatment can be drawn. We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospective cardiac prognosis.MethodPatients (n=473) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Depressive symptom dimensions were associated with baseline left ventricular ejection fraction (LVEF) and prospective cardiac death and/or recurrent MI. The average follow-up period was 2.8 years.ResultsFactor analysis revealed two symptom dimensions – somatic/affective and cognitive/affective – in the underlying structure of the BDI, identical to previous results. There were 49 events attributable to cardiac death (n=23) or recurrent MI (n=26). Somatic/affective (p=0.010) but not cognitive/affective (p=0.153) symptoms were associated with LVEF and cardiac death/recurrent MI. When controlling for the effects of previous MI and LVEF, somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI (hazard ratio 1.31, 95% confidence interval 1.02–1.69, p=0.038). Previous MI was also an independent predictor of cardiac death/recurrent MI.ConclusionsWe confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.

Endothelial dysfunction and cardiovascular mortality in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshii ◽  
T Matsuzawa ◽  
H Nakahashi ◽  
R Satou ◽  
E Akiyama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Cardiovascular Mortality ◽  
Causes Of Death ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Abstract Background Although the prognostic value of non-invasive endothelial function test has been reported in several populations including heart failure patients and angina pectoris patients, it is unknown in patients with acute coronary syndrome (ACS). Furthermore, the role of endothelial dysfunction in increased risk for specific causes of death has not been investigated. Purpose To study the relation between endothelial dysfunction and the risk of death in ACS patients, both overall and with regard to the main causes of death. Method Six hundred and ninety-two patients who were hospitalized for ACS from 2010 to 2014 were enrolled. Reactive hyoeremia index (RHI) was measured to assess endothelial function non-invasively in all patients using the peripheral arterial tonometry. RHI values below 1.67 were interpreted as signs of endothelial dysfunction in accordance with the manufacturer. Patients were followed up for a median of 6.5 years. Result A mean age (standard deviation) was 66 (12) years, and 542 patients (78%) were male. The patients in this study consist of 377 ST-elevation myocardial infarction (54%), and 263 non ST-elevation myocardial infarction (38%), and 52 unstable angina (8%). Endothelial dysfunction was detected in 276 patients (40%). During the follow-up period, 84 patients (12%) died (48 from cardiovascular disease, 36 from other causes). Patients with endothelial dysfunction had an increased risk of death (hazard ratio (HR) 1.83, 95% confidence interval (95% CI): 1.19–2.83, p=0.006) compared with those without endothelial dysfunction. Analyses for specific causes of death showed that patients with endothelial dysfunction had a 2.4-fold higher increased risk of cardiovascular death (HR: 2.44, 95% CI: 1.35 ro 4.59, p=0.003) after multivariate adjustment. However there was no significant relation between endothelial dysfunction and non-cardiovascular mortality (HR: 0.69, 95% CI: 0.34 to 1.36, p=0.29). Conclusion Endothelial dysfunction is strongly associated with an increased risk of cardiovascular mortality in ACS patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Particulate Air Pollution and Risk of Cardiovascular Events Among Adults With a History of Stroke or Acute Myocardial Infarction

2021 ◽  
Author(s):  
Noelle S. Liao ◽  
Stephen Sidney ◽  
Kamala Deosaransingh ◽  
Stephen K. Van Den Eeden ◽  
Joel Schwartz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Mortality ◽  
State Regulation ◽  
Susceptible Population ◽  
Increased Risk ◽  
Address Data ◽  
History Of ◽  
Increase In Risk ◽  
Cvd Mortality

Background Previous studies have found associations between fine particulate matter <2.5 µm in diameter (PM 2.5 ) and increased risk of cardiovascular disease (CVD) among populations with no CVD history. Less is understood about susceptibility of adults with a history of CVD and subsequent PM 2.5 ‐related CVD events and whether current regulation levels for PM 2.5 are protective for this population. Methods and Results This retrospective cohort study included 96 582 Kaiser Permanente Northern California adults with a history of stroke or acute myocardial infarction. Outcome, covariate, and address data obtained from electronic health records were linked to time‐varying 1‐year mean PM 2.5 exposure estimates based on residential locations. Cox proportional hazard models estimated risks of stroke, acute myocardial infarction, and cardiovascular mortality associated with PM 2.5 exposure, adjusting for multiple covariates. Secondary analyses estimated risks below federal and state regulation levels (12 µg/m 3 for 1‐year mean PM 2.5 ). A 10‐µg/m 3 increase in 1‐year mean PM 2.5 exposure was associated with an increase in risk of cardiovascular mortality (hazard ratio [HR], 1.20; 95% CI, 1.11–1.30), but no increase in risk of stroke or acute myocardial infarction. Analyses of <12 µg/m 3 showed increased risk for CVD mortality (HR, 2.31; 95% CI, 1.96–2.71), stroke (HR, 1.41; 95% CI, 1.09–1.83]), and acute myocardial infarction (HR, 1.51; 95% CI, 1.21–1.89) per 10‐µg/m 3 increase in 1‐year mean PM 2.5 . Conclusions Adults with a history of CVD are susceptible to the effects of PM 2.5 exposure, particularly on CVD mortality. Increased risks observed at exposure levels <12 µg/m 3 highlight that current PM 2.5 regulation levels may not be protective for this susceptible population.

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