Vascular Mechanisms of Depression in Patients with Coronary ArteryDisease Público

Abstract

Background: Depression is associated with adverse outcomes in patients with coronary artery disease (CAD), yet the mechanism underlying endothelial dysfunction post mental stress is unclear. We hypothesized that depression is associated with impaired endothelial function at baseline, and larger declines in endothelial function after laboratory-induced mental stress challenge.

Methods: This was a cross sectional study of 277 subjects with a documented history of myocardial infarction in the previous 8 months at the time of screening. Depression was assessed using Beck Depression Inventory score (BDI). Vascular function was measured by Reactive Hyperemic Index (RHI) using PAT and Flow mediated vasodilation (FMD) at baseline and post mental stress.

Results: Microvascular endothelial dysfunction (RHI) was associated with higher BDI score at baseline (P=0.03), but the change from baseline RHI to post mental stress (P=0.31) was not associated with BDI. Brachial artery endothelial function (FMD) at baseline (P=0.29) and its change after mental stress (P=0.23) were not associated with BDI score.

Conclusion: Depressive symptoms are significantly associated with microvascular endothelial dysfunction at baseline. Our study did not show a significant relationship of depressive symptoms with changes in endothelial function after mental stress challenge.

Table of Contents

INTRODUCTION............................................................................................1

METHODS....................................................................................................3

Participants..................................................................................................3

Study Design.................................................................................................4

Depression Assessment.................... ...........................................................4

Mental Stress Protocol..................................................................................4

Endothelial Function Measures....................................................................5

Endothelium-dependent flow-mediated vasodilation (FMD).......................5

Peripheral Arterial Tonometry (PAT)............................................................6

DATA ANALYSIS............................................................................................7

RESULTS.......................................................................................................8

DISCUSSION................................................................................................10

CONCLUSION..............................................................................................12

TABLE 1....................................................................................................... 13

TABLE 2....................................................................................................... 13

TABLE 3....................................................................................................... 14

TABLE 4....................................................................................................... 15

REFERENCES................................................................................................16

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	CVD Mental stress FMD Endothelium dysfunction Depression BDI PAT
Committee Chair / Thesis Advisor	Shah, Amit J, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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