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      Risk of Cardiovascular Disease Mortality in Relation to Depression and 14 Common Risk Factors

      research-article
      1 , 1
      International Journal of General Medicine
      Dove
      depression, cardiovascular disease mortality, epidemiology, NHANES

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          Abstract

          Background

          Depression has been linked to a worse prognosis of Cardiovascular disease (CVD), and these two diseases share a variety of common risk factors such as unhealthy lifestyles and chronic medical conditions. However, the potential role of these common risk factors in modulating the association between depression and CVD mortality and whether the co-occurrence of depression and a specific common risk factor has a cumulative impact on CVD mortality are still largely unknown.

          Methods

          We pooled data from 2005–2014 of Nation health and nutritional examination survey, leading to a study population of 22,177 adults. The Patient Health Questionnaire was employed to assess the depression symptoms, and information on CVD mortality was obtained from the linked mortality file of NHANES. Fourteen common risk factors of depression and CVD were included in this study.

          Results

          Based on the interaction analyses, we found overweight was protective for the risk of CVD death in depressive participants, but not in people without depression. Moreover, relative risk-based analyses indicated a mutually promotive effect of depression and baseline CVD or living alone on CVD mortality.

          Conclusion

          The novel findings in our study may facilitate risk stratification in the clinical programs targeting CVD mortality and help to shed light on the differential pathophysiological mechanisms in the depression-mediated elevation of CVD mortality.

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          Most cited references38

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          Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis.

          To assess the magnitude and direction of associations of depression with C-reactive protein (CRP), interleukin (IL)-1, and IL-6 in community and clinical samples. Systematic review of articles published between January 1967 and January 2008 in the PubMed and PsycINFO electronic databases was performed. Effect sizes were calculated as stat d and meta-analyzed, using random-effects models. Each inflammatory marker was positively associated with depression; CRP, d = 0.15 (95% CI = 0.10, 0.21), p < .001; IL-6, d = 0.25 (95% CI = 0.18, 0.31), p < .001; IL-1, d = 0.35 (95% CI = 0.03, 0.67), p = .03; IL-1ra, d = 0.25 (95% CI = 0.04, 0.46), p = .02. Associations were strongest in clinically depressed patient samples--but were also significant in community-based samples--and when clinical interviews were used. Studies adjusting for body mass index (BMI) had smaller associations, albeit significant. Relationships were inconsistent with respect to age, medication, and sex. Depression was related to CRP and IL-6 among patients with cardiac disease or cancer. Depression and CRP, IL-1, and IL-6 are positively associated in clinical and community samples and BMI is implicated as a mediating/moderating factor. Continuity in clinic- and community-based samples suggests there is a dose-response relationship between depression and these inflammatory markers, lending strength to the contention that the cardiac (or cancer) risk conferred by depression is not exclusive to patient populations. Available evidence is consistent with three causal pathways: depression to inflammation, inflammation to depression, and bidirectional relationships.
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            Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms.

            Depression's burden of disease goes beyond functioning and quality of life and extends to somatic health. Results from longitudinal cohort studies converge in illustrating that major depressive disorder (MDD) subsequently increases the risk of cardiovascular morbidity and mortality with about 80%. The impact of MDD on cardiovascular health may be partly explained by mediating mechanisms such as unhealthy lifestyle (smoking, excessive alcohol use, physical inactivity, unhealthy diet, therapy non-compliance) and unfavorable pathophysiological disturbances (autonomic, HPA-axis, metabolic and immuno-inflammatory dysregulations). A summary of the literature findings as well as relevant results from the large-scale Netherlands Study of Depression and Anxiety (N=2981) are presented. Persons with MDD have significantly worse lifestyles as well as more pathophysiological disturbances as compared to healthy controls. Some of these differences seem to be specific for (typical versus 'atypical', or antidepressant treated versus drug-naive) subgroups of MDD patients. Alternative explanations are also present, namely undetected confounding, iatrogenic effects or 'third factors' such as genetics.
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              Obesity and Prevalence of Cardiovascular Diseases and Prognosis-The Obesity Paradox Updated.

              The prevalence and severity of obesity have increased in the United States and most of the Westernized World over recent decades, reaching worldwide epidemics. Since obesity worsens most of the cardiovascular disease (CVD) risk factors, not surprisingly, most CVDs, including hypertension, coronary heart disease, heart failure, and atrial fibrillation, are all increased in the setting of obesity. However, many studies and meta-analyses have demonstrated an obesity paradox with regards to prognosis in CVD patients, with often the overweight and mildly obese having a better prognosis than do their leaner counterparts with the same CVD. The implication for fitness to markedly alter the relationship between adiposity and prognosis and the potential impact of weight loss, in light of the obesity paradox, are all reviewed.
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                Author and article information

                Journal
                Int J Gen Med
                Int J Gen Med
                ijgm
                ijgm
                International Journal of General Medicine
                Dove
                1178-7074
                12 February 2021
                2021
                : 14
                : 441-449
                Affiliations
                [1 ]School of Life Sciences, Beijing University of Chinese Medicine , Beijing, People’s Republic of China
                Author notes
                Correspondence: Sen Li School of Life Sciences, Beijing University of Chinese Medicine , Beijing, People’s Republic of China Email senli@bucm.edu.cn
                Author information
                http://orcid.org/0000-0003-4496-5050
                Article
                292140
                10.2147/IJGM.S292140
                7887189
                33603451
                d15ebec4-8990-42b7-9dd2-49dc18f4c2f5
                © 2021 Jia and Li.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 14 November 2020
                : 13 January 2021
                Page count
                Figures: 4, Tables: 2, References: 40, Pages: 9
                Funding
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                Funded by: Young Elite Scientists Sponsorship Program by CACM;
                Funded by: Distinguished Young Scholars in BUCM;
                This study is supported by the National Natural Science Foundation of China (Grant No. 81703942 and 81973698), Young Elite Scientists Sponsorship Program by CACM (Grant No. 2019-QNRC2-B08), Science Fund for Distinguished Young Scholars in BUCM (Grant No. BUCM-2019-JCRC004) and BUCM research start-up fund (to SL).
                Categories
                Original Research

                Medicine
                depression,cardiovascular disease mortality,epidemiology,nhanes
                Medicine
                depression, cardiovascular disease mortality, epidemiology, nhanes

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