Exercise, Depression, and Cardiac Risk

运动、抑郁和心脏病风险

• 批准号: 7035106
• 负责人: James A Blumenthal
• 金额: $ 76.65万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-02-01 至 2011-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7035106
• 关键词: C reactive protein; aerobic exercise; antidepressants; baroreflex; behavioral /social science research tag; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular disorder therapy; clinical research; clinical trials; comorbidity; drug screening /evaluation; functional ability; heart rate; human subject; human therapy evaluation; inflammation; major depression; mental disorder chemotherapy; patient oriented research; platelets; sertraline; vascular endothelium

DESCRIPTION (provided by applicant): Coronary heart disease (CHD) is the leading cause of death in the United States, affecting 1 million people each year. The term "cardiovascular vulnerable patient" has been used to describe patients susceptible to acute coronary events based upon plaque, blood, or myocardial characteristics. Recent evidence also has suggested that depression is a significant and independent risk factor for patients with CHD, and also may be associated with increased cardiovascular vulnerability. This evidence has provided a rationale for developing interventional strategies for treating depression in cardiac patients. Antidepressant medications, especially selective serotonin reuptake inhibitors, have been particularly effective in this regard. However, for many patients medication fails to adequately relieve depressive symptoms or does so at the cost of unwanted side effects. Thus, there is a need to identify alternative approaches for treating depression, particularly in patients with CHD. There is now good reason to believe that exercise may be one such approach. To date, however, the therapeutic potential of exercise has remained unfulfilled due to a paucity of data from well-designed clinical studies of depressed patients, and virtually no randomized controlled trials of depressed CHD patients. The study proposed in this application will build upon our previous work in which we demonstrated the feasibility and efficacy of exercise as a treatment for depression. Specifically, we propose to (a) evaluate the effectiveness of exercise training in reducing depression in vulnerable cardiac patients; (b) examine changes in intermediate endpoints, including measures of autonomic nervous system dysregulation, endothelial dysfunction, chronic inflammation, and platelet activation, which also serve as physiologic markers of cardiac vulnerability to arrhythmias, plaque rupture, and thrombosis; and (c) explore possible mechanisms by which the interventions reduce depression. Two hundred men and women with CHD and elevated symptoms of depression will be randomly assigned to Exercise, Medication, or Placebo. Before and after 3 months of treatment, patients will undergo clinical assessments of depression and measures of heart rate variability, baroreflex control, endothelial function, C-reactive protein, and platelet activity. A six month follow-up will assess maintenance of benefit and evaluate cardiac events and medical cost utilization. The data generated from this study will have important clinical significance by determining the extent to which exercise may reduce depression and improve intermediate markers of CHD risk in vulnerable cardiac patients.

描述（由申请人提供）：冠心病（CHD）是美国的主要死亡原因，每年影响100万人。术语“心血管脆弱患者”已被用于描述基于斑块、血液或心肌特征易发生急性冠状动脉事件的患者。最近的证据也表明，抑郁症是冠心病患者的一个重要和独立的危险因素，也可能与心血管脆弱性增加有关。这一证据为开发治疗心脏病患者抑郁症的干预策略提供了理论基础。抗抑郁药物，特别是选择性5-羟色胺再摄取抑制剂，在这方面特别有效。然而，对于许多患者来说，药物无法充分缓解抑郁症状，或者以不必要的副作用为代价。因此，需要确定用于治疗抑郁症的替代方法，特别是在患有CHD的患者中。现在有充分的理由相信，运动可能是这样一种方法。然而，到目前为止，运动的治疗潜力仍然没有实现，由于缺乏数据，从设计良好的抑郁症患者的临床研究，几乎没有抑郁症冠心病患者的随机对照试验。本申请中提出的研究将建立在我们以前的工作基础上，我们在这些工作中证明了运动作为抑郁症治疗方法的可行性和有效性。具体而言，我们建议：（a）评估运动训练在减少心脏脆弱患者抑郁方面的有效性;（B）检查中间终点的变化，包括自主神经系统失调、内皮功能障碍、慢性炎症和血小板活化的测量，这些也是心脏对心律失常、斑块破裂和血栓形成的脆弱性的生理标志物;以及（c）探索干预措施减少抑郁症的可能机制。将200名患有CHD和抑郁症状升高的男性和女性随机分配到运动组、药物组或安慰剂组。在治疗3个月之前和之后，患者将接受抑郁症的临床评估和心率变异性、压力反射控制、内皮功能、C反应蛋白和血小板活性的测量。6个月随访将评估获益维持情况，并评估心脏事件和医疗费用利用情况。这项研究产生的数据将具有重要的临床意义，通过确定运动在多大程度上可以减少抑郁症和改善冠心病风险的中间标志物在脆弱的心脏病患者。