Epidemiology of Depression and Heart Failure in Aging

描述(由申请人提供)：这是申请1 R01 HL079235-01的修订版。该项目的总体目标是了解抑郁症如何导致老年人的充血性心力衰竭(CHF)。众所周知，抑郁症与冠心病(CHD)风险的增加以及老年冠心病患者的不良后果有关。最近的证据表明，抑郁症也与CHF风险的增加以及老年CHF患者的不良后果有关。然而，抑郁导致充血性心力衰竭的机制尚不清楚。为了确定抑郁和CHF之间的联系机制，我们将使用1024名患有CHD的老年人(平均年龄67岁)(其中680人没有心力衰竭，344人有临床或亚临床心力衰竭)的现有队列，他们是在9/00至12/02年9：00至12/02期间招募参加心脏与灵魂研究的。“心脏与灵魂研究最初是为了了解抑郁症和冠心病之间的联系机制。由于CHD患者是CHF的高危人群，这一具有良好特征的队列将为研究抑郁症和CHF之间的关系提供一个独特的机会。在基线时，参与者完成了抑郁访谈(诊断性访谈时间表)；使用负荷超声心动图进行全面运动跑步机测试；24小时动态监测心率变异性；24小时尿液皮质醇和去甲肾上腺素；静脉血液测量血脂、血小板反应性和C反应蛋白；以及广泛的问卷调查。参与者每年都会通过电话进行跟踪。我们将邀请所有参与者回来进行为期5年的检查，之后我们将再跟踪他们3年，以确定(A)基线抑郁和CHF之间的独立关联，以及(B)与抑郁相关的生物学和行为因素的5-vear变化在多大程度上解释了抑郁和CHF之间的关系。通过确定抑郁症和充血性心力衰竭之间的关系的机制，这项研究将使我们能够针对特定的领域来改善这些患者的治疗。

DESCRIPTION (provided by applicant): This is a revision of application 1 R01 HL079235-01. The overall goal of this project is to understand how depression leads to congestive heart failure (CHF) in older adults. Depression is known to be associated with an increased risk of coronary heart disease (CHD), and with adverse outcomes among older adults with CHD. Recent evidence suggests that depression is also associated with an increased risk of CHF, and with adverse outcomes among older adults with CHF. However, the mechanisms by which depression leads to CHF are not known. To determine the mechanisms of association between depression and CHF, we will use an existing cohort of 1024 older adults (mean age 67) with CHD (including 680 with no heart failure and 344 with clinical or subclinical heart failure) who were recruited between 9/00 and 12/02 for The Heart and Soul Study." The Heart and Soul Study was originally designed to understand the mechanism of association between depression and CHD. Since patients with CHD are at high risk for CHF, this well-characterized cohort will provide a unique opportunity to examine the relation between depression and CHF. At baseline, participants completed a depression interview (Diagnostic Interview Schedule); full exercise treadmill testing with stress echocardiography; 24-hour Holter monitoring for heart rate variability; 24-hour urine collection for cortisol and norepinephrine; venous blood measurements for lipids, platelet reactivity, and C-reactive protein; and an extensive questionnaire. Participants have been followed annually by telephone. We will invite all participants to return for a 5-year examination, and we will follow them for an additional 3 years thereafter, to determine (a) the independent association between baseline depression and CHF, and (b) the extent to which 5-vear changes in biological and behavioral factors associated with depression explain the relation between depression and CHF. By identifying the mechanisms that explain the relation between depression and CHF, this study will enable us to target specific areas for improving the treatment of these patients.