Objective The present paper reviews the evidence that depression is a risk factor for the development and progression of coronary artery disease (CAD). Methods MEDLINE searches and reviews of bibliographies were used to identify relevant articles. Articles were clustered by theme: depression as a risk factor, biobehavioral mechanisms, and treatment outcome studies. Results Depression confers a relative risk between 1.5 and 2.0 for the onset of CAD in healthy individuals, whereas depression in patients with existing CAD confers a relative risk between 1.5 and 2.5 for cardiac morbidity and mortality. A number of plausible biobehavioral mechanisms linking depression and CAD have been identified, including treatment adherence, lifestyle factors, traditional risk factors, alterations in autonomic nervous system (ANS) and hypothalamic pituitary adrenal (HPA) axis functioning, platelet activation, and inflammation. Conclusion There is substantial evidence for a relationship between depression and adverse clinical outcomes. However, despite the availability of effective therapies for depression, there is a paucity of data to support the efficacy of these interventions to improve clinical outcomes for depressed CAD patients. Randomized clinical trials are needed to further evaluate the value of treating depression in CAD patients to improve survival and reduce morbidity.

Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment.

Interest in the quality of life of patients with different diseases continues to grow. Recent years have witnessed a dramatic rise in the prevalence of obesity worldwide, stimulating interest in the health and quality of life consequences of this phenomenon. The body of research on the quality of life of obese individuals has grown to a point that a review of this literature is warranted. Numerous studies have demonstrated that obese persons experience significant impairments in quality of life as a result of their obesity, with greater impairments associated with greater degrees of obesity. Weight loss has been shown to improve quality of life in obese persons undergoing a variety of treatments. Further research is needed to clarify whether quality of life differs among subsets of obese persons. Until recently, there has been little standardization of quality of life measures in obesity. The SF-36 has been used in a number of studies of obese persons. Several obesity-specific instruments have also been developed and have shown great promise. The quality of life of obese individuals is an important issue that should be included in weight management treatment and research.

Quality of life and obesity

This article critically reviews the evidence that exercise is effective in treating depression in adults. Depression is recognised as a mood state, clinical syndrome and psychiatric condition, and traditional methods for assessing depression (e.g. standard interviews, questionnaires) are described. In order to place exercise therapy into context, more established methods for treating clinical depression are discussed. Observational (e.g. cross-sectional and correlational) and interventional studies of exercise are reviewed in healthy adults, those with comorbid medical conditions, and patients with major depression. Potential mechanisms by which exercise may reduce depression are described, and directions for future research in the area are suggested. The available evidence provides considerable support for the value of exercise in reducing depressive symptoms in both healthy and clinical populations. However, many studies have significant methodological limitations. Thus, more data from carefully conducted clinical trials are needed before exercise can be recommended as an alternative to more traditional, empirically validated pharmacological and behavioural therapies.

https://web.colby.edu/essheets/files/2013/06/Exercise-and-Clinical-Depression-Brosse-et-al.pdf

Exercise and the treatment of clinical depression in adults: recent findings and future directions.

PURPOSEThe purpose of this study was to evaluate the effects of optimism, depression, and neuroticism on adherence and outcomes among patients in cardiac rehabilitation (CR).METHODSParticipants included 46 patients (34 men) with coronary heart disease (CHD) who completed measures of psychological fu

Psychological predictors of adherence and outcomes among patients in cardiac rehabilitation.

Cardiac Rehabilitation has evolved over the past decades from a simple monitoring for the safe return to physical activities to a multidisciplinary approach that focuses on patient education, individually tailored exercise training, modification of the risk factors and the overall well-being of the cardiac patients. It has been proven to be an effective tool for the care of the patients with heart disease. Recent research in cardiac rehabilitation has demonstrated that tremendous benefits can be derived from the optimal use of cardiac rehabilitation in patients with various cardiac pathologies including ischemic heart disease, heart failure and post heart surgery. The benefits of cardiac rehabilitation include mortality reduction, symptom relief, reduction in smoking and improved exercise tolerance, risk factors modification and the overall psychosocial wellbeing. Unfortunately, cardiac rehabilitation remains considerably underutilized mainly because of referral problems and poor enrollment. The development of alternate approaches and the use of transtelephonic and other means of monitoring and surveillance will help expand the utilization of cardiac rehabilitation.

/pdf/cardiac-rehabilitation-past-present-and-future-an-overview-2vwl0ekxtb.pdf

Cardiac rehabilitation past, present and future: an overview

Previous studies have indicated the benefits of cardiac rehabilitation programs after major coronary artery disease (CAD) events. We studied 591 consecutive patients from two academic institutions before and after completion of a cardiac rehabilitation and exercise training program to determine the effects of this therapy on exercise capacity, indices of obesity, plasma lipid values, behavioral characteristics, and quality of life parameters. After cardiac rehabilitation, statistically significant improvements occurred in exercise capacity (+33%), percent body fat (-6%), body mass index (-1%), HDL-C (+5%), triglycerides (-9%), LDL-C/HDL-C (-6%), anxiety score (-39%), depression score (-35%), somatization score (-37%), and in all parameters of quality of life studied (total +14%). These data further support the ability of cardiac rehabilitation and exercise training programs to improve exercise capacity, plasma lipid values, obesity indices, behavioral characteristics, and quality of life parameters in a large cohort of patients who have had major CAD events.

Effects of cardiac rehabilitation and exercise programs on exercise capacity, coronary risk factors, behavior, and quality of life in patients with coronary artery disease

A decade of research from the Ochsner Heart and Vascular Institute's cardiopulmonary rehabilitation and exercise training programs demonstrates the benefits of this therapy on coronary risk factors, exercise capacity, cardiopulmonary parameters, behavioral characteristics, and quality of life in various subgroups of patients, including the elderly, women, obese patients, and groups with dyslipidemia and psychological distress, as well as in patients with congestive heart failure or severe lung disease. Substantial data from our program support the idea that cardiopulmonary rehabilitation and exercise training programs are underemphasized and underutilized for the secondary prevention of coronary artery disease.

Cardiopulmonary Rehabilitation, Exercise Training, and Preventive Cardiology: An Overview of a Decade of Research at the Ochsner Heart and Vascular Institute

Left ventricular geometry predicts mortality in elderly with preserved systolic function: an echocardiographic study in 9771 patients over 70 years old

Several studies have indicated that left ventricular hypertrophy (LVH) predicts morbidity and mortality. Recently, a common LV geometric pattern of concentric remodeling (CR), characterized by normal LV mass indexed to body surface area (LVMI) but increased relative wall thickness (RWT; 2 x posterior wall thickness/diastolic diameter 0.43), has been associated with increased morbidity and mortality. To our knowledge, however, the prognostic impact of CR has not been studied in a large cohort of women. We studied echocardiographic and clinical data in 17,851 consecutive female patients (mean age 59.8 16.0 years) with preserved systolic function (ejection fraction 50%) referred for echocardiography and followed for 3.1 years for mortality determined by the National Death Index. LVH was defined as LVMI 104 g/m, and patients were classified as normal structure (no LVH and RWT 0.43), CR, eccentric LVH (EH; LVH with RWT 0.43) or concentric LVH (CH; LVH and RWT 0.43). Normal (52%) and CR (35%) were the most prevalent LV geometric patterns. Although patients with CR had significantly lower LVMI and higher EF than patients with normal structure, their mortality was more than double that of normals (p 0.0001) and was comparable to those with LVH (see table). Conclusions Abnormal LV geometry is common in women with normal systolic function, being present in 48% of this population, with CR being the most common abnormal geometric pattern. Concentric remodeling is present in over one third of women referred for echocardiography and is associated with significantly increased mortality compared with normal LV structure and carries a prognosis comparable to frank LVH.

Y.E. Gilliland

Papers

Effects of cardiac rehabilitation and exercise programs on exercise capacity, coronary risk factors, behavior, and quality of life in patients with coronary artery disease

Cardiopulmonary Rehabilitation, Exercise Training, and Preventive Cardiology: An Overview of a Decade of Research at the Ochsner Heart and Vascular Institute

Left ventricular geometry predicts mortality in elderly with preserved systolic function: an echocardiographic study in 9771 patients over 70 years old

Left ventricular geometry predicts mortality in women with preserved systolic function - An echocardiographic study in 17,851 patients