Metabolic syndrome and coronary artery disease in adults with congenital heart disease

Background The population of adults with congenital heart disease (CHD) has increased dramatically with a high prevalence of acquired cardiac and non-cardiac comorbidities. However, the relationship among congenital heart disease, physical comorbidities, and psychological health in this population is not well studied. Aims The purpose of this study was to investigate (a) the association between adult congenital heart disease and the occurrence of depression and (b) whether physical comorbidities mediated the association between congenital heart disease and the occurrence of depression. Methods This retrospective cohort study was followed from 1 January 2010–31 December 2013, based on the data from the National Health Insurance Research Database 2010 in Taiwan. We used mediation analysis in survival data to assess the mediated effect. The hazard ratios were adjusted by age, sex, area of residence, and estimated propensity scores. Results We recruited 2122 adult congenital heart disease patients and 8488 matched controls. Nearly half of patients diagnosed with simple congenital heart disease, 39.0% had complex congenital heart disease, and 11.2% had unclassified congenital heart disease. Adult congenital heart disease patients had a significantly higher risk of depression than matched controls (adjusted hazard ratio = 1.43 and 1.48, for all and complex congenital heart disease, respectively, p<0.05). Coronary artery disease and chronic obstructive pulmonary disease were the significant comorbidities mediating the relationship between adult congenital heart disease and depression, the proportions mediated by coronary artery disease or chronic obstructive pulmonary disease were 35.5% and 12.9%, respectively. Conclusions Helping patients to prevent psychological and physical acquired disease is imperative. Coronary artery disease is a potent mediator between congenital heart disease and depression, especially for patients with complex congenital heart disease.

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Adults With Mild‐to‐Moderate Congenital Heart Disease Demonstrate Measurable Neurocognitive Deficits

Journal of the American Heart Association ◽

10.1161/jaha.119.015379 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Melissa L. Perrotta ◽

Priyanka Saha ◽

Roy Zawadzki ◽

Mark Beidelman ◽

Erik Ingelsson ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Congenital Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Cognitive Flexibility ◽

Processing Speed ◽

Congenital Heart ◽

Trail Making ◽

Artery Disease

Background Neurocognitive impairment is a common complication of congenital heart disease (CHD) as well as acquired cardiovascular disease. Data are limited on neurocognitive function in adults with CHD (ACHD). Methods and Results A total of 1020 individuals with mild‐to‐moderate ACHD and 497 987 individuals without ACHD from the volunteer‐based UK Biobank study underwent neurocognitive tests for fluid intelligence, reaction time, numeric memory, symbol‐digit substitution, and trail making at enrollment and follow‐up. Performance scores were compared before and after exclusion of preexisting stroke or coronary artery disease as measures of cerebro‐ and cardiovascular disease. Individuals with ACHD had significantly poorer performance on alpha‐numeric trail making, a measure of visual attention and cognitive flexibility, spending 6.4 seconds longer on alpha‐numeric trail making (95% CI, 3.0–9.9 seconds, P =0.002) and 2.5 seconds longer on numeric trail making (95% CI, 0.5–4.6 seconds, P =0.034), a measure of visual attention and processing speed. The ACHD cohort had modestly lower performance on symbol‐digit substitution, a measure of processing speed, with 0.9 fewer correct substitutions (95% CI, − 1.5 to − 0.2 substitutions, P =0.021). After excluding preexisting stroke or coronary artery disease, individuals with ACHD continued to show poorer performance in all 6 domains ( P =NS). Conclusions Individuals with mild‐to‐moderate ACHD had poorer neurocognitive performance, most significantly in tests of cognitive flexibility, analogous to deficits in children with CHD. These differences appear to be driven by increased burden of cerebro‐ and cardiovascular disease among individuals with ACHD.

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