Epidemiology of Depression and Heart Failure in Aging

描述（由申请人提供）：这是对申请1 R01 h079235 -01的修订。该项目的总体目标是了解抑郁症如何导致老年人充血性心力衰竭（CHF）。众所周知，抑郁症与冠心病（CHD）的风险增加有关，并与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的风险增加有关，并与老年CHF患者的不良结局有关。然而，抑郁症导致心力衰竭的机制尚不清楚。为了确定抑郁和CHF之间的关联机制，我们将使用1024名患有冠心病的老年人（平均年龄67岁）（包括680名无心力衰竭和344名临床或亚临床心力衰竭）的现有队列，他们是在2009年9月至2002年12月期间招募的心脏和灵魂研究。”心脏和灵魂研究最初的目的是了解抑郁症和冠心病之间的联系机制。由于冠心病患者是发生CHF的高危人群，这个特征明确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，参与者完成抑郁症访谈（诊断访谈表）；负荷超声心动图的全运动跑步机试验24小时动态心电图监测心率变异性；24小时尿液收集皮质醇和去甲肾上腺素；静脉血测量血脂、血小板反应性和c反应蛋白；以及一份广泛的调查问卷。参与者每年都接受电话随访。我们将邀请所有参与者返回进行为期5年的检查，之后我们将对他们进行额外的3年随访，以确定(a)基线抑郁与CHF之间的独立关联，以及(b)与抑郁相关的5年生物学和行为因素的变化在多大程度上解释抑郁与CHF之间的关系。通过确定解释抑郁症和CHF之间关系的机制，这项研究将使我们能够针对特定领域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.