Psychosocial Factors and Risk of Incident Heart Failure

Abstract

Background Heart failure is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease, but not for heart failure. Methods and Results We examined the relationship between psychological status and incident heart failure among 6,782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales and physician reviewers adjudicated incident heart failure events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow up of 9.3 years, 242 participants developed incident heart failure. There was no association between psychosocial factors and heart failure hazard ratios (95% CI) for highest vs. lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high vs. low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident heart failure, but there was no association for those with good/very good/excellent self-reported health. Conclusions Overall these psychosocial factors were not significantly associated with incident heart failure. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of heart failure. Future research with greater statistical power is necessary to replicate these findings and seek explanations.

Aspects of diastolic dysfunction in patients with new and recurrent depression

“…The association between MDD and early-onset atherosclerosis was analyzed in several studies. For example, Smith and Singer [5] debated the role of AS in the bidirectional relationship between depression and cardiovascular comorbidity in patients with MDD. In the Maastricht study, Onete et al [13] evaluated MDD by using the Mini-International Neuropsychiatric Interview (MINI) and the Patient Health Questionnaire-9 (PHQ-9).…”

“…Thus, they found an increased incidence of heart failure in depressed patients, which was associated with elevated mortality. Similarly, Ogilvie [5] examined the relationship between psychological status and incidence of heart failure in 6782 individuals from the Multi-Ethnic Study of Atherosclerosis and reported that depressive symptoms were associated with an increased risk of heart failure. In a recent study, Wang et al [25] also analyzed these aspects in a smaller group and concluded that MDD is a prevalent and independent predictor of mortality in patients with diabetes mellitus and heart failure.…”

“…It is a well-recognized theory that depression is commonly associated with an unhealthy lifestyle, which results from a variety of factors, such as a poor diet and a sedentary lifestyle, which may, in turn, lead to obesity. Additionally, other unhealthy lifestyle choices, such as smoking, alcohol misuse, inconsistent treatment adherence, taken individually or in association with other potential individual risk factors, such as diabetes mellitus and dyslipidemia, may contribute to an early onset of atherosclerosis [5]. Moreover, findings from various clinical studies provide robust evidence on the complex relationship between MDD and CVD, as they appear to share common socio-demographic, psychosocial, and biological pathways.…”

A novel approach for measuring residential socioeconomic factors associated with cardiovascular and metabolic health

“…First, we did not measure psychosocial stress or the built environment. 2,43–46 However, the importance of missing psychosocial stress may be minimal, as the relationship between psychosocial stress and disease have been inconsistent, 5,18,24,47–50 and healthy behavior is linked with both the built environment and SES. 51 In addition, we did not survey our cohort to determine why the patients lived in their neighborhoods and we were also missing information on the past residences of some the participants.…”

Impact of Therapy with Selective Serotonine-Reuptake Inhibitors on the Evolution of Subclinical Atherosclerosis in Patients with Depressive Disorder

“…In subjects without CVD, MDD is associated with a high risk of developing atherosclerosis and heart failure and in patients with coronary artery disease (CAD), arrhythmias or heart failure, it represents a negative prognosis factor [3]. The relation between MDD and CVD is complex and multifactorial, as both pathologies share common sociodemographic, psychosocial, behavioral and biological pathways [4,5]. There are several pathophysiological pathways shared by the two illnesses.…”