Comorbid Depression is Associated with Increased Major Adverse Limb Events in Peripheral Arterial Disease: A Systematic Review and Meta-analysis

Abi-Jaoude, Joanne; Naiem, Ahmed; Edwards, Thomas; Lukaszewski, Marie-Amélie; Obrand, Daniel I.; Steinmetz, Oren K.; Bayne, Jason; MacKenzie, Kent S.; Gill, Heather L.; Girsowicz, Elie

doi:10.1016/j.ejvs.2022.04.020

Cited by 5 publications

(2 citation statements)

References 42 publications

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“…PAD patients suffering from depressive symptoms are more likely to have other clinical symptoms such as chest discomfort, shortness of breath, and heart palpitations [ 15 ]. In addition, comorbid depressive symptoms are associated with an increased risk of PAD events [ 19 ], secondary cardiovascular events [ 22 ], major amputations [ 20 , 70 ] and mortality [ 13 ]. Finally, PAD patients with depressive symptoms are less willing to exercise [ 69 ] and more likely to have recurrent symptoms after revascularization [ 66 ], which may further aggravate PAD symptoms.…”

Section: Discussionmentioning

confidence: 99%

Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis

et al. 2022

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Introduction Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. Methods A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Results Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). Discussion The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.

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Section: Discussionmentioning

confidence: 99%

Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis

et al. 2022

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“…According to a meta-analysis covering 20 studies, the prevalence of depression in patients with PAD was estimated to be 13%. This comorbidity has been found to augment the risk of adverse limb consequences, notably intermittent claudication, by 20%; at the same time, these patients are accompanied by more complications such as chest pain and palpitations ( 127 , 128 ). In addition, PAD patients afflicted with depression are characterized by heightened risks of amputation and mortality, decreased walking function and a lower quality of life ( 29 , 128 – 130 ).…”

Section: Relationship Between Specific Macrovascular Disease and Depr...mentioning

confidence: 99%

Association between depression and macrovascular disease: a mini review

2023

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Depression and macrovascular diseases are globally recognized as significant disorders that pose a substantial socioeconomic burden because of their associated disability and mortality. In addition, comorbidities between depression and macrovascular diseases have been widely reported in clinical settings. Patients afflicted with coronary artery disease, cerebrovascular disease or peripheral artery disease exhibit an elevated propensity for depressive symptoms. These symptoms, in turn, augment the risk of macrovascular diseases, thereby reflecting a bidirectional relationship. This review examines the physiological and pathological mechanisms behind comorbidity while also examining the intricate connection between depression and macrovascular diseases. The present mechanisms are significantly impacted by atypical activity in the hypothalamic–pituitary–adrenal axis. Elevated levels of cortisol and other hormones may disrupt normal endothelial cell function, resulting in vascular narrowing. At the same time, proinflammatory cytokines like interleukin-1 and C-reactive protein have been shown to disrupt the normal function of neurons and microglia by affecting blood–brain barrier permeability in the brain, exacerbating depressive symptoms. In addition, platelet hyperactivation or aggregation, endothelial dysfunction, and autonomic nervous system dysfunction are important comorbidity mechanisms. Collectively, these mechanisms provide a plausible physiological basis for the interplay between these two diseases. Interdisciplinary collaboration is crucial for future research aiming to reveal the pathogenesis of comorbidity and develop customised prevention and treatment strategies.

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The enigma of vascular depression in old age: a critical update

Ka¹

2022

J Neural Transm

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Comorbid Depression is Associated with Increased Major Adverse Limb Events in Peripheral Arterial Disease: A Systematic Review and Meta-analysis

Cited by 5 publications

References 42 publications

Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis

Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis

Association between depression and macrovascular disease: a mini review

The enigma of vascular depression in old age: a critical update

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