BACKGROUND:Depressive symptoms have been associated with increased risk of coronary artery disease and poor prognosis among patients with existing coronary artery disease, but whether depressive symptoms specifically influence atherosclerotic progression among such patients is uncertain. METHODS AND RESULTS: The Post-CABG Trial randomized patients with a history of coronary bypass graft surgery to either an aggressive or a moderate lipid-lowering strategy and to eitherwarfarin or placebo. Coronary angiography was conducted at enrollment and after a median follow-up of 4.2 years. Depressive symptoms were assessed at enrollment with the Centers for Epidemiologic Studies Depression scale (CES-D) in 1319 patients with 2496 grafts. In models that adjusted for age, gender, race, treatment assignment, and years since coronary bypass graft surgery, a CES-D score > or =16 was positively associated with risk of substantial graft disease progression (OR 1.50, 95% CI 1.08 to 2.10, P=0.02) and marginally associated with a 0.11-mm (95% CI -0.22 to 0.01 mm, P=0.07) decrease in minimum lumen diameter, but not with risk of graft occlusion (P=0.30). Additional adjustment for past medical history, blood pressure, and renal function did not materially alter these results. This association was virtually absent among participants randomly assigned to aggressive lipid-lowering therapy. CONCLUSIONS: These findings suggest that depressive symptoms are associated with a higher risk of atherosclerotic progression among patients with saphenous vein grafts and that aggressive lipid lowering can minimize this increased risk. Whether depressive symptoms increase progression in other types of coronary atherosclerosis and whether aggressive lipid lowering attenuates such progression will require additional study.
RCT Entities:
BACKGROUND:Depressive symptoms have been associated with increased risk of coronary artery disease and poor prognosis among patients with existing coronary artery disease, but whether depressive symptoms specifically influence atherosclerotic progression among such patients is uncertain. METHODS AND RESULTS: The Post-CABG Trial randomized patients with a history of coronary bypass graft surgery to either an aggressive or a moderate lipid-lowering strategy and to either warfarin or placebo. Coronary angiography was conducted at enrollment and after a median follow-up of 4.2 years. Depressive symptoms were assessed at enrollment with the Centers for Epidemiologic Studies Depression scale (CES-D) in 1319 patients with 2496 grafts. In models that adjusted for age, gender, race, treatment assignment, and years since coronary bypass graft surgery, a CES-D score > or =16 was positively associated with risk of substantial graft disease progression (OR 1.50, 95% CI 1.08 to 2.10, P=0.02) and marginally associated with a 0.11-mm (95% CI -0.22 to 0.01 mm, P=0.07) decrease in minimum lumen diameter, but not with risk of graft occlusion (P=0.30). Additional adjustment for past medical history, blood pressure, and renal function did not materially alter these results. This association was virtually absent among participants randomly assigned to aggressive lipid-lowering therapy. CONCLUSIONS: These findings suggest that depressive symptoms are associated with a higher risk of atherosclerotic progression among patients with saphenous vein grafts and that aggressive lipid lowering can minimize this increased risk. Whether depressive symptoms increase progression in other types of coronary atherosclerosis and whether aggressive lipid lowering attenuates such progression will require additional study.
Authors: Susmita Mallik; Harlan M Krumholz; Zhen Qiu Lin; Stanislav V Kasl; Jennifer A Mattera; Sarah A Roumains; Viola Vaccarino Journal: Circulation Date: 2005-01-17 Impact factor: 29.690
Authors: William Whang; Christine M Albert; Samuel F Sears; Rachel Lampert; Jamie B Conti; Paul J Wang; Jagmeet P Singh; Jeremy N Ruskin; James E Muller; Murray A Mittleman Journal: J Am Coll Cardiol Date: 2005-04-05 Impact factor: 24.094
Authors: Donald C Haas; Karina W Davidson; Daniel J Schwartz; Nina Rieckmann; Mary J Roman; Thomas G Pickering; William Gerin; Joseph E Schwartz Journal: Am J Cardiol Date: 2005-02-15 Impact factor: 2.778
Authors: Ali Sadoughi; Kari E Roberts; Ioana R Preston; Ginny P Lai; Deborah H McCollister; Harrison W Farber; Nicholas S Hill Journal: Chest Date: 2013-08 Impact factor: 9.410
Authors: Tam Truong Donnelly; Jassim Mohd Al Suwaidi; Awad Al-Qahtani; Nidal Asaad; Najlaa Abdul Qader; Rajvir Singh; Tak Shing Fung; Irem Mueed; Shima Sharara; Noha El Banna; Sarah Omar Journal: J Immigr Minor Health Date: 2015-08
Authors: Karen A Matthews; Yue-Fang Chang; Kim Sutton-Tyrrell; Daniel Edmundowicz; Joyce T Bromberger Journal: Psychosom Med Date: 2010-07-28 Impact factor: 4.312
Authors: M Urooj Zafar; Manuel Paz-Yepes; Daichi Shimbo; Gemma Vilahur; Matthew M Burg; William Chaplin; Valentin Fuster; Karina W Davidson; Juan J Badimon Journal: Eur Heart J Date: 2010-01-22 Impact factor: 29.983
Authors: Mary A Whooley; Peter de Jonge; Eric Vittinghoff; Christian Otte; Rudolf Moos; Robert M Carney; Sadia Ali; Sunaina Dowray; Beeya Na; Mitchell D Feldman; Nelson B Schiller; Warren S Browner Journal: JAMA Date: 2008-11-26 Impact factor: 56.272
Authors: Jeff C Huffman; Christopher M Celano; Scott R Beach; Shweta R Motiwala; James L Januzzi Journal: Cardiovasc Psychiatry Neurol Date: 2013-04-07