Percutaneous transluminal angioplasty: Association between depressive symptoms and diminished health status benefits

Smolderen, Kim G.; Safley, David M.; House, John A.; Spertus, John A.; Marso, Steven P.

doi:10.1177/1358863x11415568

Cited by 26 publications

(31 citation statements)

References 32 publications

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“…In addition to increasing the risk of PAD, depression also appears to impact the functional status and symptoms of patients with PAD, leading to more dramatic annual declines in functional performance 13 , reduced walking distance 14 , and reduced quality of life benefit following revascularization 15 . The findings from this study add to a growing body of literature on behavioral and psychosocial risk factors in the development of cardiovascular disorders.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral arterial disease, gender, and depression in the Heart and Soul Study

Grenon

Cohen

Smolderen

et al. 2014

Journal of Vascular Surgery

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Background Despite the high prevalence of peripheral artery disease (PAD) in women, risk factors for PAD in women are not well understood. Methods Gender-specific risk factors for PAD were examined in a prospective cohort study of 1024 patients (184 women and 840 men) with stable coronary artery disease who were recruited between 2000 to 2002. Logistic regression models were used to evaluate associations between traditional and non-traditional risk factors and PAD in both men and women. Results 11% of women and 13% of men were found to have PAD. Women with PAD had a similar prevalence of traditional risk factors (hypertension, hyperlipidemia, and smoking) compared to women without PAD. Women with PAD were significantly more likely to suffer from depression than women without PAD. Men with PAD were more likely to have hypertension, diabetes mellitus, a history of smoking, a worse lipid profile and higher levels of inflammatory biomarkers compared to men without PAD. In a multivariate model, depression was the only significant factor associated with PAD in women while smoking and elevated fibrinogen were independently associated with PAD in men. Conclusions The current findings suggest gender differences in risk factors for the development of PAD. Further research is needed to understand the role of depression in PAD.

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Section: Discussionmentioning

confidence: 99%

“…A score of 10 or higher has a sensitivity of 88% and a specificity of 88% for major depressive disorders 29 . The PHQ-9 has been previously used for diagnosis purposes in patients with PAD 15 . Anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS) 30 .…”

Section: Methodsmentioning

confidence: 99%

Peripheral arterial disease, gender, and depression in the Heart and Soul Study

Grenon

Cohen

Smolderen

et al. 2014

Journal of Vascular Surgery

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“…35 The Patient Health Questionnaire-9 has been used successfully in patients with PAD previously. 22 …”

Section: Methodsmentioning

confidence: 99%

Association Between Depression and Peripheral Artery Disease: Insights From the Heart and Soul Study

Grenon

Hiramoto

Smolderen

et al. 2012

JAHA

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Background Depression is known to increase the risk of coronary artery disease, but few studies have evaluated the association between depression and peripheral artery disease (PAD). We examined the association of depression with PAD and evaluated potential mediators of this association. Methods and Results We used data from the Heart and Soul Study, a prospective cohort of 1024 men and women with coronary artery disease recruited in 2000–2002 and followed for a mean of 7.2±2.6 years. Depressive symptoms were assessed with the validated 9‐item Patient Health Questionnaire. Prevalent PAD at baseline was determined by self‐report. Prospective PAD events were adjudicated on the basis of review of medical records. We used logistic regression and Cox proportional‐hazards models to estimate the independent associations of depressive symptoms with prevalent PAD and subsequent PAD events. At baseline, 199 patients (19%) had depressive symptoms (Patient Health Questionnaire ≥10). Prevalent PAD was reported by 12% of patients with depression and 7% of those without depression (base model adjusted for age and sex: odds ratio 1.79, 95% confidence interval 1.06–3.04, P=0.03; full model adjusted for comorbidities, medications, PAD risk factors, inflammation, and health behaviors: odds ratio 1.59, 95% confidence interval 0.90–2.83, P=0.11). During follow‐up, PAD events occurred in 7% of patients with depression and 5% of those without depression (base model adjusted for age and sex: hazard ratio 2.09, 95% confidence interval 1.09–4.00, P=0.03; full model adjusted for comorbidities, medications, PAD risk factors, inflammation, and health behaviors: hazard ratio 1.33, 95% confidence interval 0.65–2.71, P=0.44). Factors explaining >5% of the association between depression and incident PAD events included race/ethnicity, diabetes, congestive heart failure, high‐density lipoprotein, triglyceride levels, serum creatinine, inflammation, smoking, and levels of physical activity. Conclusions Depressive symptoms were associated with a greater risk of PAD. Because the association was explained partly by modifiable risk factors, our findings suggest that more aggressive treatment of these risk factors could reduce the excess risk of PAD associated with depression.

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“…77 Similar associations between depression and patient health status have been found in patients with atrial fibrillation and PAD. 78,79 In contrast, traditional cardiac disease severity indices (eg, left ventricular ejection fraction, myocardial ischemia) are only weakly associated with patient-reported health status. [10][11][12][13] Also, depressive symptoms are associated with less of a health status benefit with revascularization and predict which patients will show no improvement in functional status 6 months after CABG surgery, which highlights depression as a cofactor in the evaluation of treatment recovery.…”

Section: Health Status and Depressionmentioning

confidence: 99%

“…[10][11][12][13] Also, depressive symptoms are associated with less of a health status benefit with revascularization and predict which patients will show no improvement in functional status 6 months after CABG surgery, which highlights depression as a cofactor in the evaluation of treatment recovery. 79,80 The sum of literature to date supports that depression is common in cardiovascular populations and is strongly associated with worse patient health status, above and beyond traditional cardiac or clinical variables. 81 As such, studies of patient health status in cardiovascular populations, and particularly evaluation of interventions aimed at improving patient symptoms, functional status, and quality of life, should assess patients for depression.…”

Section: Health Status and Depressionmentioning

confidence: 99%