Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study

Abstract

Background Randomized controlled trials focusing on the effects of antidepressant treatment in cardiac patients have found modest effects on depressive symptoms but not on cardiac outcomes. A secondary analysis was conducted on data from the Enhancing Recovery in Coronary Heart Disease trial to assess whether changes in somatic or cognitive depressive symptoms following acute MI predicted event-free survival and whether the results differed per treatment arm (cognitive behavior therapy or care as usual). Methods Patients who met depression criteria and completed the 6th month depression assessment (n=1254) were included in this study. Measurements included demographic and clinical data and the Beck Depression Inventory at baseline and 6 months. The primary endpoint was a composite of recurrent MI and mortality over 2.4 years (standard deviation=0.9 years). Results Positive changes (per 1 point increase) in somatic depressive symptoms (HR: 0.95; 95% CI: 0.92–0.98; p=0.001) but not in cognitive depressive symptoms (HR: 0.98; 95% CI: 0.96–1.01; p=0.19) were related to a reduced risk of recurrent MI and mortality after adjustment for baseline depression scores. There was a trend for an interaction effect between changes in somatic depressive symptoms and the intervention (p=0.08). After controlling for demographic and clinical variables, the association between changes in somatic depressive symptoms and event-free survival remained significant in the intervention arm (HR: 0.93; 95% CI: 0.88–0.98; p=0.01) only. Limitations Secondary analyses. Conclusions Changes in somatic depressive symptoms, and not cognitive symptoms, were related to improved outcomes in the intervention arm, independent of demographic and clinical variables.

The role of neutrophil gelatinase associated lipocalin (NGAL) as biological constituent linking depression and cardiovascular disease

“…In patients with stable coronary heart disease, somatic symptoms of depression are associated with cardiac events, while there is no significant association of cognitive symptoms of depression with cardiac prognosis (Hoen et al, 2010). Later the same results were found for somatic symptoms of depression in patients that suffered acute myocardial infarction (Roest et al, 2013). Additionally, in chronic heart failure somatic symptoms of depression are associated with all-cause mortality, while cognitive symptoms of depression are not (Schiffer et al, 2009).…”

Cognitive Function in Heart Failure Is Associated With Nonsomatic Symptoms of Depression But Not Somatic Symptoms

“…21 Indeed, these symptom clusters have been shown to have differential impact on HF outcomes 22, 23 as well as other indices of cardiovascular function. 24–29 For example, some studies found that the somatic symptoms cluster (e.g., sleep disturbance, appetite changes, and low energy) was the strongest predictor across a variety of outcomes, 22, 25, 29 whereas other studies reported similar results for the nonsomatic symptom clusters (e.g., cognitive, affective, or behavioral symptoms). 23, 26–28 For example, Schiffer et al 22 found that individuals with high somatic symptom scores had a greater incidence of mortality than those with low scores (31% vs. 15%; hazard ratio = 2.3).…”

Association of depression with adverse cardiovascular events after percutaneous coronary intervention

“…Antidepressant medications, such as sertraline, have been reported to result in decreased mortality and MI risks for patients with coronary artery disease and concomitant depression [30,31]. Changes in depressive symptoms were also found to be related to improved outcomes in patients with MI [32]. The effect of antidepressant medications on patients undergoing PCI should be verified in future studies.…”