Mental health conditions and cardiovascular diseases: association and risk stratification based on genetics, lifestyle, and biomarkers

关键词：心理健康；心血管疾病;危险分层;预测心血管疾病（CVD）的算法通常关注传统的危险因素（如吸烟）和生物标志物（如胆固醇），尽管流行病学和孟德尔随机化研究已经表明，包括重度抑郁症在内的精神健康状况是CVD的病因。然而，这种关系尚不清楚，还有几个重要的问题，例如，这种关联是动脉粥样硬化性心血管疾病特有的，还是延伸到其他心血管疾病，如心房颤动和心力衰竭？焦虑症，另一种常见的精神健康状况，也能预测心血管疾病吗？抑郁、焦虑和心血管疾病之间的潜在途径是什么？也许更重要的是，为什么有些有精神健康状况的人会患上心血管疾病，而有些人却不会，原因也是难以捉摸的。这为心血管疾病心理健康状况患者的风险分层提供了独特的机会，也为将心理健康纳入一般心血管疾病预测算法提供了潜在的机会。目的：本博士的总体目标是利用现有的大数据（英国生物银行和初级保健数据）调查心理健康和心血管疾病之间的关系，目标如下：1。研究焦虑障碍与CVD类型（ASCVD、AF、HF、PAD）之间的关系，以及在现有CVD预测模型（如AHA/ACC或SCORE）中添加焦虑的任何其他预测效用。探讨心理健康状况（包括抑郁和焦虑）与CVD3之间的机制通路（介质）。确定与心血管疾病风险相关的风险因素（遗传、生活方式、生物标志物）和心理健康之间的任何相互作用

Keywords: Mental health; cardiovascular; risk stratification; epidemiology Algorithms for predicting cardiovascular disease (CVD) often focus on traditional risk factors (e.g. smoking) and biomarkers (e.g. cholesterol) even though epidemiological and Mendelian randomisation studies have shown mental health conditions, including major depressive disorder, to be causal of CVD. However, the relationship is not well understood with several important remaining questions, e.g. Is the association specific to atherosclerotic CVD, or does it extend to other CVDs, such as atrial fibrillation and heart failure? Is anxiety disorder, another common mental health condition, also predictive of CVDs? What are the underlying pathways between depression, anxiety and CVD? Perhaps more importantly, the reasons why some people with mental health conditions developed CVD but some do not is also elusive. This presents a unique opportunity for risk stratifying people with mental health conditions for CVD, as well as to the potential inclusion of mental health in the general CVD prediction algorithms.Aims: The overarching aim of this PhD would be to investigate the association between mental health and CVD using existing big data (UK Biobank and primary care data) with the following objectives:1. To study the association between anxiety disorder and types of CVD (ASCVD, AF, HF, PAD), as well as any additional prediction utility of adding anxiety to existing CVD prediction models (e.g. AHA/ACC or SCORE)2. To explore the mechanistic pathways (mediators) connecting mental health conditions (including depression and anxiety) and CVD3. To identify any interactions between risk factors (genetics, lifestyle, biomarkers) and mental health in relation to the risk of CVD