Depression, even when undiagnosed, can have many negative effects on cardiovascular patients, including poor healthcare experiences, more use of healthcare resources and higher health costs, according to preliminary research presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018, a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, healthcare professionals and policymakers.
About one-fifth of cardiovascular disease patients suffer from depression.
“While we don’t know which comes first — depression or cardiovascular disease — the consensus is that depression is a risk marker for cardiovascular disease, meaning if you have cardiovascular disease, there is a higher likelihood that you could also have depression, when compared with the risk in the general population,” said Victor Okunrintemi, M.D., M.P.H., a research fellow at Baptist Health South Florida in Coral Gables, Florida, and lead author of a pair of studies that looked into different aspects of depression and cardiovascular disease.
Final results from the RESPECT trial found that percutaneously closing a patent foramen ovale (PFO) using the Amplatzer PFO Occluder was superior to medical management in the prevention of recurrent ischemic stroke in patients who previously had a cryptogenic stroke.
Findings were reported at the 28th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world’s premier educational meeting specializing in interventional cardiovascular medicine. The U.S. Food and Drug Administration (FDA) recently approved the device for recurrent stroke prevention in patients with a PFO and history of cryptogenic stroke on the basis of these data.
A PFO is a small hole between the atria that did not close completely early in life and which can allow a venous system clot to enter the left atrium and travel to the brain causing a stroke. Current guidelines call for medical management with anticoagulants or antiplatelet drugs for patients with PFO following a cryptogenic stroke. The RESPECT study examined the use of a device that closes the hole percutaneously versus medical management. From 2003 to 2011, a total of 980 subjects between 18 and 60 years of age were randomized to PFO Closure (N=499) or medical management (N=481) at 69 sites in the United States and Canada. The newest study results further extended follow-up, analyzing data from August 2003 through May 2016 for outcomes of recurrent ischemic strokes and recurrent ischemic strokes of unknown mechanism.
Younger women with coronary heart disease and mental stress are more susceptible to myocardial ischemia (reduced blood flow to the heart muscle, which can lead to a heart attack), compared to men and older patients, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
Coronary heart disease is a leading cause of death in American men and women, but studies show that younger women have higher rates of complications and death after a heart attack compared to their male counterparts.
“Younger women tend to have quite a lot of stress in their lives. Many of them have full-time jobs and at the same time have numerous responsibilities at home; financial hardship, as well as depression and anxiety which are common in this group,” said Viola Vaccarino, M.D., Ph.D., lead study author, professor and chair of the department of epidemiology at Emory University in Atlanta, Georgia. “Clinicians should ask about stress and emotional difficulties in these patients and recommend ways to help, such as finding time to relax and exercise.”
“Depression is almost three times more common in people who have had a heart attack than in those who haven’t,” said Dr Manuela Abreu, a psychiatrist at the University of Lisbon, Portugal. “Cardiac rehabilitation with aerobic exercise can reduce depressive symptoms and improve cardiovascular fitness.”
“Patients who are depressed after a heart attack have a two-fold risk of having another heart attack or dying compared to those who are not depressed,” added Dr David Nanchen, head of the Prevention Centre, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.
Dr Nanchen’s research shows that exercise and stopping smoking may improve depression after heart attack. He studied 1,164 patients who were part of the Swiss Acute Coronary Syndromes (ACS) cohort, a large prospective multicentre study of patients with ACS in Switzerland. Patients were enrolled between 2009 and 2013 and followed up for one year. Depression was assessed at enrolment and at one year.
Having a high stress job may be linked to a higher risk of stroke, according to an analysis of several studies. The meta-analysis is published in the October 14, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“Having a lot of job stress has been linked to heart disease, but studies on job stress and stroke have shown inconsistent results,” said Dingli Xu, MD, with Southern Medical University in Guangzhou, China. “It’s possible that high stress jobs lead to more unhealthy behaviors, such as poor eating habits, smoking and a lack of exercise.”
The analysis looked at all of the available research on job strain and stroke risk. The six studies analyzed involved a total of 138,782 participants who were followed for three to 17 years.
Manipulating the neck has been associated with cervical dissection, a type of arterial tear that can lead to stroke. Although a direct cause-and-effect link has not been established between neck manipulation and the risk of stroke, healthcare providers should inform patients of the association before they undergo neck manipulation.
Treatments involving neck manipulation may be associated with stroke, though it cannot be said with certainty that neck manipulation causes strokes, according to a new scientific statement published in the American Heart Association’s journal Stroke.
Cervical artery dissection (CD) is a small tear in the layers of artery walls in the neck. It can result in ischemic stroke if a blood clot forms after a trivial or major trauma in the neck and later causes blockage of a blood vessel in the brain. Cervical artery dissection is an important cause of stroke in young and middle-aged adults.