Endothelial dysfunction in people with depressive disorders: A systematic review and meta-analysis

Waclawovsky, Aline Josiane; Brito, Edineia de; Smıth, Lee; Vancampfort, Davy; Silva, Antônio M.V. da; Schuch, Felipe Barreto

doi:10.1016/j.jpsychires.2021.06.045

Cited by 20 publications

(16 citation statements)

References 38 publications

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“…Depressive symptoms have been correlated with CVD prevalence in the population, and some studies 20 have reported that patients with depression are more likely to develop endothelial dysfunction compared to the normal population, this may constitute a possible mechanism for the association of depression with CVD. Furthermore, animal experiments have shown that depressive behavior in mice correlates with left ventricular wall thickness and elevated levels of acetyl heparin (HS) and chondroitin sulfate (CS) in the heart, 21 which suggest that depression may alter cardiovascular physiology and lead to adverse cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Zhao,

Gao,

Lin

et al. 2023

NSS

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Introduction Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease (CVD). Depression is a crucial factor among the various factors that are associated with OSA and CVD. Purpose This study was conducted with an aim to assess the prognostic significance of depression on the MACE in older patients with OSA. Patients and Methods 1106 older patients with OSA, without myocardial infarction (MI), history of hospitalization for unstable angina, or heart failure at baseline were enrolled and followed up prospectively. Incidence rates were expressed as cumulative incidence. Cox proportional hazards analysis was used to estimate the risk of all events. The primary outcomes were major adverse cardiovascular events (MACE). Each patient underwent polysomnography (PSG) and GDS-12 scale assessment. Those with an apnea-hypopnea index (AHI) greater than 5 were diagnosed with OSA, while those with a scale score greater than 3 were diagnosed with depression. Results Among the 1106 older patients with OSA, depression was found in 133(12.0%) patients, 96(8.7%) patients experienced MACE during the follow-up. Depression was associated with a higher cumulative incidence of MACE in older patients with OSA. Multivariate analysis revealed that depression independently increased the risk of MACE (adjusted hazard ratio [aHR] = 2.29; 95% confidence interval [CI]: 1.34–3.90; P = 0.002). Subgroup analyses showed that male patients (aHR = 2.96; 95% CI: 1.52–5.77; P = 0.001), overweight-obese individuals (aHR = 2.98; 95% CI: 1.49–6.00; P = 0.002), and those with moderate-severe OSA (aHR = 2.82; 95% CI: 1.55–5.14; P = 0.001) and concurrent depression were at a higher risk for MACE. Conclusion Depression is common in older patients with OSA in the absence of MI, hospitalization for unstable angina, or heart failure, and confers an independent, increased risk of MACE.

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Section: Discussionmentioning

confidence: 99%

Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Zhao,

Gao,

Lin

et al. 2023

NSS

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“…All of these factors contribute to atherosclerosis and worsening PAD. [76][77][78] These 2 considerations further highlight the importance of addressing mental health from a personcentered, humanistic, and ethical perspective, as well as from a biological and pathophysiological perspective.…”

Section: Mental Health and Pad Treatment Considerationsmentioning

confidence: 99%

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association

Smolderen,

Samaan,

Decker

et al. 2023

Circulation

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Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.

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“…This suggests that transient, repeated stress, as encountered during daily life, may result in clinically relevant effects, such as atherosclerosis and MSIMI [ 21 ]. Moreover, individuals with clinical depression have impaired endothelial function, which may account for their increased risk of CAD [ 22 ].…”

Section: Recognised Underlying Mechanisms That Can Be Measured In Lab...mentioning

confidence: 99%

The Impact of Mental Stress on Cardiovascular Health—Part II

Henein

Vancheri

Longo³

et al. 2022

JCM

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Endothelial dysfunction is one of the earliest manifestations of atherosclerosis, contributing to its development and progression. Mental stress induces endothelial dysfunction through increased activity of the sympathetic nervous system, release of corticotropin-releasing hormone from the hypothalamus, inhibition of nitric oxide (NO) synthesis by cortisol, and increased levels of pro-inflammatory cytokines. Mental-stress-induced increased output of the sympathetic nervous system and concomitant withdrawal of the parasympathetic inflammatory reflex results in systemic inflammation and activation of a neural–hematopoietic–arterial axis. This includes the brainstem and subcortical regions network, bone marrow activation, release of leukocytes into the circulation and their migration to the arterial wall and atherosclerotic plaques. Low-grade, sterile inflammation is involved in all steps of atherogenesis, from coronary plaque formation to destabilisation and rupture. Increased sympathetic tone may cause arterial smooth-muscle-cell proliferation, resulting in vascular hypertrophy, thus contributing to the development of hypertension. Emotional events also cause instability of cardiac repolarisation due to brain lateralised imbalance of cardiac autonomic nervous stimulation, which may lead to asymmetric repolarisation and arrhythmia. Acute emotional stress can also provoke severe catecholamine release, leading to direct myocyte injury due to calcium overload, known as myocytolysis, coronary microvascular vasoconstriction, and an increase in left ventricular afterload. These changes can trigger a heart failure syndrome mimicking acute myocardial infarction, characterised by transient left ventricular dysfunction and apical ballooning, known as stress (Takotsubo) cardiomyopathy. Women are more prone than men to develop mental-stress-induced myocardial ischemia (MSIMI), probably reflecting gender differences in brain activation patterns during mental stress. Although guidelines on CV prevention recognise psychosocial factors as risk modifiers to improve risk prediction and decision making, the evidence that their assessment and treatment will prevent CAD needs further evaluation.

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Endothelial dysfunction in people with depressive disorders: A systematic review and meta-analysis

Cited by 20 publications

References 38 publications

Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Association of Depression with Long-Term Cardiovascular Risks in Older Patients with Obstructive Sleep Apnea

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association

The Impact of Mental Stress on Cardiovascular Health—Part II

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