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1年主要不良心脏事件（MACE）和全因死亡率（ACM）的相关性很强，且独立于其他已知的风险因素。然而，我们对这种关联的机制的理解仍然有限。这项拟议的辅助研究将建立在我们的母项目项目，抑郁症，生物行为机制和CHD/死亡率结果的基础上。母研究测试了药物依从性、血小板聚集和炎症标志物作为解释抑郁症过度MACE/ACM风险的可能机制。然而，最近令人兴奋的研究结果表明，抑郁，稳定的心脏病患者的MACE/ACM风险过高在很大程度上是由于体力活动减少。母研究中未检测该机制。我们建议增加一个客观的，连续的，90天的身体活动评估，使用体动记录仪，一个新的队列研究的1400例患者在医院登记的ACS事件的时间。结合临床抑郁症的结构化访谈诊断、抑郁症状和自我报告的体力活动评估以及对母研究中已纳入的所有受试者的MACE/ACM的12个月跟踪，这将使我们能够检验体力活动介导抑郁症和心脏结局风险之间关系的假设。在母研究中增加体动记录仪具有时间敏感性，因为我们无法回顾性收集这些数据。母研究通过增加一个待探索的机制而受益。如果得到证实，这将扩大稳定的心脏病患者的最新结果的普遍性，ACS后的人口。具体而言，我们将测试：1）ACS围期抑郁患者在随后3个月内从事较少的体力活动; 2）出院后3个月内较低水平的体力活动与随后9个月内MACE/ACM风险增加相关;和3）当体力活动在统计学上被控制时，抑郁和MACE/ACM之间的独立关联显著降低，支持身体活动作为媒介的作用。创新：ACS患者出院后稳定增加体力活动是治疗指南的主要组成部分;据我们所知，这将是第一项使用体动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：ACS后的身体活动是可以改变的，它的缺乏本身就是一个巨大的公共卫生问题。如果抑郁症患者在ACS住院后通过客观评估减少了身体活动，这可以解释他们的过度风险的很大一部分，我们将有基础的观察数据来提出对该患者人群的运动干预。