Psychological distress and mortality in stable coronary heart disease: persistence of high distress means increased risk

Heart ◽  
2017 ◽  
Vol 103 (23) ◽  
pp. 1840-1841 ◽  
Author(s):  
Gjin Ndrepepa
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Psychological Distress ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
High Distress ◽  
Disease Persistence

scholarly journals Prognostic value of long-term trajectories of depression for incident diabetes mellitus in patients with stable coronary heart disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Raphael S. Peter ◽  
Andrea Jaensch ◽  
Ute Mons ◽  
Ben Schöttker ◽  
Roman Schmucker ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Prognostic Value ◽  
Depression Symptom ◽  
Symptoms Of Depression ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
Symptom Trajectory

Abstract Background Diabetes mellitus (DM) and depression are bidirectionally interrelated. We recently identified long-term trajectories of depression symptom severity in individuals with coronary heart disease (CHD), which were associated with the risk for subsequent cardiovascular events (CVE). We now investigated the prognostic value of these trajectories of symptoms of depression with the risk of incident DM in patients with stable coronary heart disease. Methods The KAROLA cohort included CHD patients participating in an in-patient rehabilitation program (years 1999/2000) and followed for up to 15 years. We included 1048 patients (mean age 59.4 years, 15% female) with information on prevalent DM at baseline and follow-up data. Cox proportional hazards models were used to model the risk for incident DM during follow-up by depression trajectory class adjusted for age, sex, education, smoking status, body mass index, and physical activity. In addition, we modeled the excess risk for subsequent CVE due to incident DM during follow-up for each of the depression trajectories. Results DM was prevalent in 20.7% of patients at baseline. Over follow-up, 296 (28.2%) of patients had a subsequent CVE. During follow-up, 157 (15.0%) patients developed incident DM before experiencing a subsequent CVE. Patients following a high-stable depression symptom trajectory were at substantially higher risk of developing incident DM than patients following a low-stable depression symptom trajectory (hazard ratio (HR) = 2.50; 95% confidence interval (CI) (1.35, 4.65)). A moderate-stable and an increasing depression trajectory were associated with HRs of 1.48 (95%-CI (1.10, 1.98)) and 1.77 (95%-CI (1.00, 3.15)) for incident DM. In addition, patients in the high-stable depression trajectory class who developed incident DM during follow-up were at 6.5-fold risk (HR = 6.51; 95%-CI (2.77, 15.3)) of experiencing a subsequent cardiovascular event. Conclusions In patients with CHD, following a trajectory of high stable symptoms of depression was associated with an increased risk of incident DM. Furthermore, incident DM in these patients was associated with a substantially increased risk of subsequent CVE. Identifying depressive symptoms and pertinent treatment offers might be an important and promising approach to enhance outcomes in patients with CHD, which should be followed up in further research and practice.

scholarly journals Associations between psychosocial burden and prognostic biomarkers in patients with stable coronary heart disease – a STABILITY substudy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Wassberg ◽  
G Batra ◽  
N Hadziosmanovic ◽  
E Hagstrom ◽  
H White ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin T ◽  
Geometric Mean ◽  
Funding Source ◽  
Psychosocial Burden ◽  
Private Company ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
The Stability

Abstract Background Psychosocial burden is associated with increased risk of cardiovascular (CV) events in patients with stable coronary heart disease (CHD). The underlying mechanisms linking psychosocial burden and CHD are unclear and might be explained by studying biomarkers known to be associated with CV risk. Methods 15,608 patients in the STABILITY trial completed a questionnaire on to what extent they were feeling down, had loss of interest, experienced financial stress and if they were living alone. Levels of high-sensitivity (hs) C-reactive protein (hs-CRP), interleukin-6 (IL-6), hs-troponin T (hs-TnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP) were assessed at baseline. Associations between levels of psychosocial burden (sometimes, often/always vs. never/rarely) and biomarkers were evaluated in a linear model where geometric mean ratio of the log-transformed biomarker were calculated. Results Adjusted associations (age, gender and established CV risk factors) are presented in the table. Conclusion Psychosocial burden in patients with stable CHD was independently associated with elevated biomarkers. The underlying association is likely to be complex and involve multiple pathways. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The STABILITY study was funded by GlaxoSmithKline. Roche Diagnostics, Rotkreuz, Switzerland, supported the research by providing the GDF-15 assay free of charge.

2212Body mass index and its association to cardiovascular outcomes in patients with stable coronary heart disease - experiences from the STABILITY study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Held ◽  
N Hadziosmanovic ◽  
E Hagstrom ◽  
J S Hochman ◽  
R A H Stewart ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Waist Circumference ◽  
Cox Regression ◽  
Preventive Treatment ◽  
Stability Study ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Stable Coronary Heart Disease

Abstract Background Obesity, assessed as body mass index (BMI), is an established risk factor for development of coronary heart disease (CHD). However, in patients with heart failure and atrial fibrillation there is an “obesity paradox” with better prognosis among obese patients. The association between BMI and cardiovascular outcomes in patients with stable CHD is unclear. Methods The prospective STABILITY trial included 15,828 patients with stable CHD with a follow-up of 3–5 years (median 3.7) on optimal secondary preventive treatment. BMI and waist circumference were measured at baseline (n=15,785). All cardiovascular outcomes were centrally adjudicated. Associations between obesity indices and outcomes were evaluated by multivariable Cox regression analyses with adjustments for age, sex, study treatment, and clinical risk factors. Results Mean age was 64 years and 19% were females. In total, 3250 (20.9%) patients had BMI <25, 6628 (42.8%), BMI >25 and <30 and 5614 (36.3%), BMI >30. Underweight (BMI <18.5) was seen in 79 patients. Most risk markers (diabetes, hypertension, and levels of inflammatory biomarkers and triglycerides) showed a graded association with higher BMI. The frequency of smoking and levels of HDL, GDF-15 and NT-proBNP were higher at lower BMI. Lower BMI was associated with an increased risk of MACE, total and CV death, and heart failure (Figure). Higher BMI was associated with increased risk of the same outcomes and also with MI. BMI was not associated with the risk of stroke. There was no interaction with age, sex, diabetes or type of MI (type 1 vs type 2–5). Associations between waist circumference and outcomes were weaker and not significant in the fully adjusted model. Figure 1 Conclusion In patients with stable CHD on optimal secondary prevention BMI had a U-shaped association with the risk of MACE, death, and heart failure and a linear association with the risk of MI. The lowest risk for MACE was seen for BMI between 25 and 30, considered as overweight. The findings do not support current recommendations to achieve an ideal BMI of 20–25 for weight adjustments in patients with CHD. Acknowledgement/Funding The original STABILITY study was funded by GlaxoSmithKline

P4988Beta-blockers in diabetes with stable coronary heart disease - a cause for concern?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A H Malik ◽  
S Shetty ◽  
K Kar ◽  
R El Accaoui
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Fixed Effects ◽  
Meta Analysis ◽  
P Value ◽  
Effect Estimate ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
All Cause Mortality

Abstract Background Beta-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarises the evidence relating to the BB therapy in diabetic patients with stable CHD. Methods A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool the odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at p-value <0.05. Heterogeneity was assessed by I2. Results Four non-randomized studies with 9,515 participants were selected for the analyses. Four studies were post-hoc analyses of randomised controlled trials, and 1 article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27%, and 32% respectively; p-value <0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI 0.94–1.33; p-value =0.22). Conclusion BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomised trials are needed in this population to confirm these findings. Acknowledgement/Funding None

scholarly journals Joint association between education and polygenic risk score for incident coronary heart disease events: a longitudinal population-based study of 26 203 men and women

2021 ◽  
pp. jech-2020-214358
Author(s):  
Pekka Martikainen ◽  
Kaarina Korhonen ◽  
Aline Jelenkovic ◽  
Hannu Lahtinen ◽  
Aki Havulinna ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Risk Score ◽  
Density Lipoprotein ◽  
Population Based ◽  
Polygenic Risk Score ◽  
Genome Wide ◽  
Increased Risk ◽  
Region Of Residence

BackgroundGenetic vulnerability to coronary heart disease (CHD) is well established, but little is known whether these effects are mediated or modified by equally well-established social determinants of CHD. We estimate the joint associations of the polygenetic risk score (PRS) for CHD and education on CHD events.MethodsThe data are from the 1992, 1997, 2002, 2007 and 2012 surveys of the population-based FINRISK Study including measures of social, behavioural and metabolic factors and genome-wide genotypes (N=26 203). Follow-up of fatal and non-fatal incident CHD events (N=2063) was based on nationwide registers.ResultsAllowing for age, sex, study year, region of residence, study batch and principal components, those in the highest quartile of PRS for CHD had strongly increased risk of CHD events compared with the lowest quartile (HR=2.26; 95% CI: 1.97 to 2.59); associations were also observed for low education (HR=1.58; 95% CI: 1.32 to 1.89). These effects were largely independent of each other. Adjustment for baseline smoking, alcohol use, body mass index, igh-density lipoprotein (HDL) and total cholesterol, blood pressure and diabetes attenuated the PRS associations by 10% and the education associations by 50%. We do not find strong evidence of interactions between PRS and education.ConclusionsPRS and education predict CHD events, and these associations are independent of each other. Both can improve CHD prediction beyond behavioural risks. The results imply that observational studies that do not have information on genetic risk factors for CHD do not provide confounded estimates for the association between education and CHD.

scholarly journals Is Childhood Socioeconomic Status Related to Coronary Heart Disease? Evidence From the Health and Retirement Study (1992-2012)

2017 ◽  
Vol 3 ◽  
pp. 233372141769667 ◽  
Author(s):  
Minjee Lee ◽  
M. Mahmud Khan ◽  
Brad Wright
Keyword(s):  
Socioeconomic Status ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Later Life ◽  
Study Data ◽  
Health And Retirement Study ◽  
Increased Risk ◽  
Childhood Socioeconomic Status ◽  
Nationally Representative ◽  
Retirement Study

Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years ( N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans.

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