Cortisol Awakening Reaction and Anxiety in Depressed Coronary Artery Disease Patients

Disturbances of HPA axis functioning as represented by cortisol awakening reaction (CAR) belong to the mediating pathways linking psychosocial distress and cardiovascular risk. Both depression and anxiety have been confirmed as independent risk factors for coronary artery disease (CAD). However, data on anxiety and cortisol output in CAD patients are scarce. Based on previous data, we hypothesized that anxiety would be associated with higher cortisol output and a more pronounced morning increase in moderately depressed CAD patients. 77 patients (60 y, 79% male) underwent saliva sampling (+0, +30, +45, +60 min after awakening, midday and late-night sample). Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS) and patients were grouped into anxious versus non anxious subjects based upon the recommended score (≥11). A repeated measures ANOVA yielded a significant time and quadratic time effect referring to the typical CAR. Anxious patients showed a significantly steeper 30 min increase, higher AUCi, lower waking and late-night cortisol levels. The steeper cortisol increase in the anxious group is in line with previous data and may be interpreted as a biological substrate of affect regulation. The lower basal and late-night levels coupled with greater AUCi mirror a more dynamic reactivity pattern compared to depressed subjects without anxiety.

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Serum Levels of FGF21, β-Klotho, and BDNF in Stable Coronary Artery Disease Patients With Depressive Symptoms: A Cross-Sectional Single-Center Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.587492 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yeshun Wu ◽

Zijun Chen ◽

Jiahao Duan ◽

Kai Huang ◽

Bin Zhu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Depressive Symptoms ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Depression Scale ◽

Serum Levels ◽

Fibroblast Growth Factor 21 ◽

Healthy Population ◽

Cross Sectional ◽

Artery Disease

Background: The incidence of depressive symptoms (DS) in patients with stable coronary artery disease (SCAD) is significantly higher than those in healthy population, and that DS are independent risk factors for cardiovascular events. Previous studies have reported that fibroblast growth factor 21 (FGF21), β-klotho, mature brain-derived neurotrophic factor (mBDNF), and BDNF precursor (proBDNF) play important roles in the pathogenesis and treatment of coronary heart disease and depression. With this in mind, the present study aimed to clarify the relationship between FGF21, β-klotho, mBDNF, and proBDNF and SCAD with comorbid depression, in addition to also exploring the underlying mechanisms of these disease processes.Methods: A total of 116 patients with SCAD and 45 healthy controls were recruited. Patients with SCAD were further divided into two subgroups based on the Zung Self-Rating Depression Scale (SDS), which were characterized as those with no DS (NDS) and those with DS. Baseline data were collected, and serum levels of FGF21, β-klotho, mBDNF, and proBDNF were determined.Results: In SCAD patients, Gensini scores—denoting the degree of coronary arteriostenosis—were significantly greater in the DS group than in the NDS group. There was also a positive correlation between the Gensini scores and the SDS scores. Patients in the SCAD group demonstrated a lower serum FGF21. Serum β-klotho, mBDNF, and mBDNF/proBDNF were also significantly lower in the DS group than in the NDS group. Furthermore, β-klotho and mBDNF were negatively correlated with the SDS scores. Additionally, SCAD patients were divided into lower- and higher-level groups using hierarchical cluster analysis, with the results highlighting that patients in the lower mBDNF group had a higher incidence of DS.Conclusions: The depression score was positively correlated with the severity of coronary artery stenosis, and serum FGF21, β-klotho, mBDNF, and proBDNF were closely related to the development of DS in patients with SCAD. These observations suggest FGF21, β-klotho, mBDNF, and proBDNF as potential diagnostic and/or therapeutic targets for SCAD with co-morbid depression.

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The use of psychometric methods for the diagnosis of anxiety and depressive disorders in patients with a general somatic profile

Kazan medical journal ◽

10.17816/kmj2019-565 ◽

2019 ◽

Vol 100 (4) ◽

pp. 565-570

Author(s):

I V Dubatova ◽

V G Voyakina ◽

S V Lepyavka ◽

A V Safronenko ◽

I A Demidov

Keyword(s):

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Arterial Hypertension ◽

Cardiovascular System ◽

Depressive Disorders ◽

Depression Scale ◽

Anxiety And Depression ◽

Artery Disease

Aim. To identify and compare the level of anxiety and depression in therapeutic patients with somatic pathology, establish the structure of the gender distribution of anxiety and depressive disorders. Methods. The study involved 126 people: 74 (58.73%) women and 52 (41.27%) men aged 21–59 years. 59 patients had diseases of the respiratory system (chronic bronchitis in the acute stage with an asthmatic component), 67 patients with cardiovascular diseases (40 subjects with coronary heart disease, 27 subjects with arterial hypertension). In 11 patients with coronary artery disease and 13 patients with hypertension, type I thyrotoxicosis was diagnosed. Clinical psychopathological, psychometric, psychological and statistical methods were used in the study. Psychometric tests were used: the Depression Scale of the Center for Epidemiological Research; Hospital Anxiety and Depression Scale and Taylor Anxiety Disorder Scale adapted by T.A. Nemchinova and V.G. Norakidze, adapted standardized multivariate questionnaire for personality research. Results. According to the severity of anxiety and depressive disorders, patients were divided into the groups: group 1 with severe level, group 2 with a moderate (subclinical) level, and group 3 with mild (not exceeding the norm) anxiety and depressive disorders. Severe and moderate disorders are most characteristic for the pathology of cardiovascular system. In coronary artery disease and arterial hypertension, abnormal (severe and moderate) anxiety and depressive disorders were observed in 24/29 (82.76%) and 20/22 (90.9%) patients, respectively. In patients with abnormal anxiety and depressive disorders, the number of women prevailed over men in the subgroup with hypertension (80% versus 20%, p=0.025) as well as in combination of hypertension with type 1 thyrotoxicosis (85.7% versus 14.3%, р=0.029). Conclusion. In patients, severe and moderate anxiety and depressive disorders are associated with the development of the pathology of cardiovascular system: coronary heart disease and arterial hypertension.

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Effects of Aerobic Exercises on Patients With Coronary Artery Disease

Journal of Exercise Science and Medicine ◽

10.32598/jesm.12.1.4 ◽

2020 ◽

Vol 12 (1) ◽

pp. 167-178

Author(s):

Farhad Rahmani-Nia ◽

◽

Arash Layegh ◽

Naser Aslanabadi ◽

◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Lipid Profile ◽

Repeated Measures ◽

Aerobic Training ◽

Beta Blockers ◽

Positive Effects ◽

Cholesterol Levels ◽

Artery Disease ◽

Adrenergic Beta Antagonists

Introduction: Prescribing the Adrenergic beta-Antagonists is very common in treating cardiovascular diseases. The aim of this study was to compare the effects of aerobic training in patients with coronary artery disease, prescribed two different types of beta-blockers (selective and non- selective) on the patient's lipid profile (Lipoproteins) and FBS (Blood Glucose). Materials and Methods: Sixty patients with coronary artery disease, aged 45-65 years, were compared in two groups of selective (n=36) and non-selective (n=24) users of beta-blockers. The training program consisted of 8 weeks of aerobic exercise on the treadmill (3 sessions per week, about 50 minutes per session, with an intensity of 40% to 60% of the heart rate reserve). Each study patient’s lipid profile and FBS level were obtained before the onset of the study and after the end of the intervention. The collected data were analyzed using repeated-measures Analysis of Variance (ANOVA). Results: In the selective group, lipid profile and FBS did not significantly change. In the non-selective group, FBS and triglyceride levels were significantly reduced after the intervention; however, HDL, LDL, and total cholesterol levels were not significantly changed (P>0.05). Conclusion: The results of this study showed that aerobic training in patients with CAD who used non-selective beta-blockers has more positive effects.

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Intensive Patients’ Education and Lifestyle Improving Program in CAD Patients

Western Journal of Nursing Research ◽

10.1177/0193945918810205 ◽

2018 ◽

Vol 41 (9) ◽

pp. 1254-1269

Author(s):

Chunyan Nie ◽

Tianzhu Li ◽

Xiaoxia Guo

Keyword(s):

Coronary Artery Disease ◽

Overall Survival ◽

Coronary Artery ◽

Usual Care ◽

Depression Scale ◽

Anxiety And Depression ◽

Control Group ◽

Hospital Anxiety ◽

Artery Disease ◽

Anxiety Depression

The objective of this article is to investigate the effects of intensive patients’ education and lifestyle improving program (IPEL) on anxiety, depression, and overall survival (OS) in coronary artery disease (CAD) patients with anxiety and depression. In all, 224 CAD patients with anxiety and depression were randomly assigned to IPEL or control group. In Stage I, the IPEL group received IPEL and usual care, while the control group only received usual care. In Stage II, patients were further followed up and OS analysis was performed. Hospital Anxiety and Depression Scale–anxiety (HADS-A) and HADS–depression (HADS-D) were used to assess anxiety and depression. IPEL reduced HADS-A score at Month 9 (M9)/M12, and the percentage of anxiety at M12 and HADS-A score changed. IPEL reduced HADS-D score at M12, and the percentage of depression at M12 and HADS-D score changed compared with control. Patients with nonanxiety/nondepression at M12 in the IPEL group showed better OS. IPEL reduces anxiety and depression and improves OS in CAD patients.

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Anxiety and Depression among Patients with Coronary Artery Disease Attending at a Cardiac Center, Kathmandu, Nepal

Nursing Research and Practice ◽

10.1155/2018/4181952 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Puja Sharma Dhital ◽

Kalpana Sharma ◽

Pratik Poudel ◽

Pankaj Raj Dhital

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Family Income ◽

Psychiatric Morbidity ◽

Depression Scale ◽

Self Esteem ◽

Anxiety And Depression ◽

Bivariate Analysis ◽

Semistructured Interview ◽

Artery Disease

Psychiatric morbidity such as anxiety and depression is common among patients with coronary artery disease (CAD). The coexistence of psychiatric morbidity negatively affects the outcome of treatment and increases the overall burden of disease in CAD patients. The objective of the study was to identify the level of anxiety and depression among patients with CAD. Descriptive, cross-sectional research design and purposive sampling were used and a total of 168 patients having coronary artery disease were selected purposively for the study from the patients attending cardiac outpatient department of Sahid Gangalaal National Heart Center, Kathmandu, Nepal. Data was collected on 2017 by using pretested semistructured interview schedule, Hospital Anxiety and Depression Scale. The findings showed that 27.4% of the respondents had anxiety caseness and 23.8% of the respondents had depression caseness. Bivariate analysis showed that patient’s level of anxiety was significantly associated with sex, family income, occupation status, and self-esteem. Higher level of anxiety (42.4%) was found in female than male patients. Likewise, level of depression was significantly associated with education status, occupation status, presence of comorbidities, physical exercise, and self-esteem of the patients. There was significant positive relationship between anxiety and depression score. Thus anxiety and depression were common among patients with CAD. Hence, anxiety and depression in CAD patients need be monitored regularly, provide regular counseling services, and refer the patients for the treatment when needed.

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An item-level analysis of the Center for Epidemiologic Studies Depression Scale (CES-D) by race and ethnicity in patients with coronary artery disease

International Journal of Geriatric Psychiatry ◽

10.1002/gps.2029 ◽

2008 ◽

Vol 23 (10) ◽

pp. 1034-1039 ◽

Cited By ~ 17

Author(s):

Carla Boutin-Foster

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Race And Ethnicity ◽

Depression Scale ◽

Epidemiologic Studies ◽

Item Level ◽

Artery Disease ◽

Level Analysis

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Psychometric Features of the Polish Version of TSK Heart in Elderly Patients with Coronary Artery Disease

Medicina ◽

10.3390/medicina56090467 ◽

2020 ◽

Vol 56 (9) ◽

pp. 467

Author(s):

Andrzej Knapik ◽

Józefa Dąbek ◽

Weronika Gallert-Kopyto ◽

Ryszard Plinta ◽

Anna Brzęk

Keyword(s):

Physical Activity ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Depression Scale ◽

Principal Component ◽

Practical Experience ◽

Anxiety And Depression ◽

Polish Version ◽

Artery Disease ◽

Stable Cad

Background and objectives: Recommendations for the control of stable patients with coronary artery disease (CAD) related to an adequate level of physical activity (PA). Practical experience shows that the PA level in most people with CAD is definitely too low in relation to the guidelines. The cause may be psychological factors and among them the fear of movement—kinesiophobia. The aim of this project was to examine the evaluation of psychometric features of the Polish version of the Tampa Scale for Kinesiophobia Heart (TSK Heart), used in people with CAD. Materials and methods: The study involved 287 patients with stable CAD: 112 women and 175 men. Age: 63.50 (SD = 11.49) years. Kinesiophobia was assessed using TSK Heart, physical activity (PA)—using the International Physical Activity Questionnaire (IPAQ), and anxiety and depression was examined using the Hospital Anxiety and Depression Scale (HADS). The structure of TSK was examined using principal component analysis (PCA), internal cohesion (Cronbach’s alpha, AC), and content validity was calculated by linear regression. Results: PCA showed a three-factor TSK structure. One-dimensionality and satisfactory reliability were found: TSK Heart: AC = 0.878. Kinesiophobia as a predictor of PA: R2 = 0.162 (p = 0.000000). Anxiety and depression—TSK: R2 = 0.093 (p = 0.00000). Conclusions: The Polish version of TSK Heart for cardiac patients is characterized by good psychometric features. The use of it can improve the cooperation of rehabilitation teams for patients with CAD.

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Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2007.06.005 ◽

2007 ◽

Vol 29 (5) ◽

pp. 417-424 ◽

Cited By ~ 149

Author(s):

Lesley Stafford ◽

Michael Berk ◽

Henry J. Jackson

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Depression Scale ◽

Patient Health Questionnaire ◽

Anxiety And Depression ◽

Health Questionnaire ◽

Hospital Anxiety ◽

Patient Health ◽

Artery Disease

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Medication Adherence and its Related Factors in Patients Undergoing Coronary Artery Angioplasty

Journal of Caring Sciences ◽

10.15171/jcs.2018.032 ◽

2018 ◽

Vol 7 (4) ◽

pp. 213-218 ◽

Cited By ~ 1

Author(s):

Arsalan Salari ◽

Leila Rouhi Balasi ◽

Asieh Ashouri ◽

Fatemeh Moaddab ◽

Fatemeh Zaersabet ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Medication Adherence ◽

Cardiac Rehabilitation ◽

Univariate Analysis ◽

Depression Scale ◽

Main Concern ◽

Related Factors ◽

Coronary Artery Atherosclerosis ◽

Artery Disease

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. Results: The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.

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