Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study

Abstract

BACKGROUND Emerging evidence indicates that the association between depression and subsequent cardiovascular events is largely mediated by health behaviors. However, it is unclear whether depression is the cause or the consequence of poor health behaviors. PURPOSE To examine prospective, bidirectional relationships of depressive symptoms with behavioral and lifestyle factors among patients with coronary heart disease. METHODS Depressive symptoms and lifestyle behaviors (physical activity, medication adherence, body mass index, waist-to-hip ratio, sleep quality, and smoking status) were assessed at baseline and 5 years later among a prospective cohort of 667 patients with stable coronary heart disease. RESULTS Greater depressive symptoms at baseline predicted poorer lifestyle behaviors 5 years later (less physical activity, lower medication adherence, higher body mass index, higher waist-to-hip ratio, worse sleep quality, and smoking). After adjustment for demographics, cardiac disease severity, comorbidity, and baseline lifestyle behaviors, depressive symptom severity remained predictive of subsequent worsening of physical activity (beta = −0.08; 95% CI= −0.16, −0.01; p = 0.03), medication adherence (beta = −0.16; 95% CI= −0.24, −0.08; p < 0.001), and sleep quality (beta = −0.19; 95% CI = −0.27, −0.11; p < 0.001). Baseline lifestyle behaviors also predicted 5-year change in depressive symptoms, although the associations were attenuated after adjustment for baseline depressive symptoms and covariates. CONCLUSIONS Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence, and sleep quality.

Lower Serum Uric Acid Is Associated With Post-Stroke Depression at Discharge

“…Compared with the patients without PSD at discharge, our results also demonstrated that the PSD patients had significantly increased stroke severity (higher NIHSS scores) and worse functional outcome (higher mRS scores and lower BI scores), which were consistent with the previous studies (18,19). The patients from PSD group were also more likely to have history of coronary artery diseases and surgery which may potentially worsen the stroke patients' conditions and increase the risk of occurrence of PSD at discharge (20). Furthermore, the incidence of PSD was higher in older stroke patients, which was also consistent with the previous reports (21).…”

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