Physical Activity, Depression, and Post-ACS Survival

体力活动、抑郁和 ACS 后生存

• 批准号: 7935569
• 负责人: JOSEPH E. SCHWARTZ
• 金额: $ 19.97万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7935569
• 关键词: Accounting; Aerobic; Age; Ancillary Study; Arousal; Behavioral; Biological; Cardiac; Chronic; Clinical; Clinical Trials; Cohort Studies; Data; Diagnosis; Dose; Elements; Endogenous depression; Enrollment; Event; Exercise; Future; Gender; Guidelines; Heart; Heart Diseases; Hospitalization; Hospitals; Intervention; Interview; Knowledge; Link; Major Depressive Disorder; Measures; Mediating; Mediator of activation protein; Modeling; Monitor; Outcome; Parents; Pathogenicity; Pathway interactions; Patient Self-Report; Patients; Physical activity; Platelet aggregation; Population; Prognostic Factor; Public Health; Risk; Risk Factors; Role; Severities; Severity of illness; Sleep; Smoking Status; Structure; Testing; Time; Treadmill Tests; actigraphy; acute coronary syndrome; awake; base; biobehavior; cardiac depression; cohort; depressed; depression; depressive symptoms; design; experience; hazard; improved; inflammatory marker; innovation; medication compliance; mortality; patient population; programs; public health relevance; sedentary; single episode major depressive disorder

DESCRIPTION (provided by applicant): The association of depression status and severity to 1-year major adverse cardiac events (MACE) and allcause mortality (ACM) after acute coronary syndrome (ACS) is strong and independent of other known risk factors. However, our understanding of the mechanisms underlying this association remains limited. This proposed ancillary study will build on our parent program project, Depression, Biobehavioral Mechanisms, & CHD/Mortality Outcomes. The parent study tests medication adherence, platelet aggregation, and inflammatory markers as possible mechanisms explaining depression's excess MACE/ACM risk. However, recent, exciting findings suggest that depressed, stable cardiac patients' excess MACE/ACM risk is largely explained by less physical activity. This mechanism is not being tested in the parent study. We propose adding an objective, continuous, 90-day assessment of physical activity, using actigraphy, to a new cohort study of 1400 patients enrolled in hospital at the time of an ACS event. This, in combination with the structured interview diagnosis of clinical depression, the assessments of depressive symptoms and selfreported physical activity, and the 12-month tracking of all subjects for MACE/ACM that are already included in the parent study, will enable us to test the hypothesis that physical (in)activity mediates the relationship between depression and cardiac outcome risk. The addition of actigraphy to the parent study is time-sensitive, as we cannot collect these data retrospectively. The parent study benefits by adding one more mechanism to be explored. If confirmed, this will extend the generalizability of the recent findings of stable cardiac patients to a post-ACS population. Specifically, we will test that:1) Patients who are depressed peri-ACS engage in less physical activity during the subsequent 3 months; 2) Lower levels of physical activity during the 3 months post-discharge are associated with increased risk for MACE/ACM during the subsequent 9 months; and 3) The independent association between depression and MACE/ACM is substantially reduced when physical activity is statistically controlled, supporting the role of physical activity as a mediator. Innovation: Having ACS patients steadily increase their physical activity after hospital discharge is a major component of treatment guidelines; to our knowledge, this will be the first study to use actigraphy to continuously monitor physical activity for an extended period following hospital discharge. PUBLIC HEALTH RELEVANCE: Physical activity post-ACS is modifiable, and its lack is a huge public health problem in its own right. If depressed patients are less physically active by objective assessment following ACS hospitalization, and this explains a substantial portion of their excess risk, we will have foundational observational data to propose an exercise intervention in this patient population.

描述(由申请人提供)： 抑郁状态和严重程度与急性冠脉综合征(ACS)后一年的主要不良心脏事件(MACE)和全因死亡率(ACM)之间的相关性很强，并且独立于其他已知的危险因素。然而，我们对这种联系背后的机制的了解仍然有限。这项拟议的辅助研究将建立在我们的父项目--抑郁、生物行为机制和CHD/死亡率结果的基础上。母公司的研究测试了药物依从性、血小板聚集和炎症标记物作为解释抑郁症过度的MACE/ACM风险的可能机制。然而，最近令人兴奋的发现表明，抑郁、稳定的心脏病患者过度的MACE/ACM风险在很大程度上是由较少的体力活动造成的。这一机制没有在母公司的研究中进行测试。我们建议在一项新的队列研究中增加一项客观的、连续的、90天的体力活动评估，该评估使用肌动描记术，对1400名在发生急性冠脉综合征事件时入院的患者进行研究。结合对临床抑郁症的结构化访谈诊断，对抑郁症状和自我报告的体力活动的评估，以及对已包括在母公司研究中的所有MACE/ACM受试者的12个月跟踪，将使我们能够检验体力活动在抑郁和心脏结局风险之间的关系中起中介作用的假设。由于我们不能回溯性地收集这些数据，因此将活动记录仪添加到母体研究中是时间敏感的。家长研究的好处在于增加了一个有待探索的机制。如果得到证实，这将把最近稳定的心脏病患者的发现推广到急性冠脉综合征后的人群。具体地说，我们将测试：1)急性冠脉综合征周围抑郁症患者在随后的3个月内从事较少的体力活动；2)出院后3个月内体力活动水平较低与随后9个月内MACE/ACM的风险增加相关；3)当体力活动被统计控制时，抑郁症与MACE/ACM之间的独立关联显著降低，支持体力活动作为中介的作用。创新：让急性冠脉综合征患者在出院后稳步增加体力活动是治疗指南的一个主要组成部分；据我们所知，这将是第一项使用肌动记录仪在出院后较长时间内持续监测体力活动的研究。公共卫生相关性：急性冠脉综合征后的体力活动是可以修改的，缺乏体力活动本身就是一个巨大的公共卫生问题。如果在急性冠脉综合征住院后，客观评估抑郁症患者的体力活动较少，这解释了他们超额风险的很大一部分，我们将有基础的观察数据来建议在这一患者群体中进行运动干预。