Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review.

This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET-CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed.

The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study.

PURPOSE: To examine the natural course and outcome of major depressive disorder (MDD) in primary care over 39 months. METHODS: Prospective cohort study of 1,338 consecutive attendees with follow-up after 6, 12, and 39 months with DSM-IV MDD using the Composite International Diagnostic Interview (CIDI). We measured severity of depressive symptoms (Patient Health Questionnaire 9), somatic symptoms (Patient Health Questionnaire 15), and mental and physical function (Short Form 12, mental and physical component summary). Analysis of variance and random coefficient models were performed. RESULTS: At baseline, 174 people (13%) had MDD of which 17% had a chronic and 40% had a fluctuating course, while 43% remitted. Patients with chronic courses had more severe depressive symptoms (mean difference 6.54; 95% CI 4.38-8.70), somatic symptoms (mean difference 3.31; 95% CI 1.61-5.02), and greater mental dysfunction (mean difference -10.49; 95% CI -14.42 to -6.57) at baseline than those who remitted from baseline, independent of age, sex, level of education, presence of a chronic disease, and a lifetime history of depression. CONCLUSIONS: Although 43% of patients with MDD attending primary care recover, this leaves a majority of patients (57%) who have a chronic or intermittent course. Chronic courses are associated with higher levels of depressive symptoms and somatic symptoms and greater mental dysfunction at baseline.

Does recognition of depression in primary care affect outcome? The PREDICT-NL study.

BACKGROUND: Detection rates of depression in primary care are <50%. Studies showed similar outcome after 12 months for recognized and unrecognized depression. Outcome beyond 12 months is less well studied. OBJECTIVE: We investigated recognition of depression in primary care and its relation to outcome after 6, 12 and 39 months. METHODS: Data were used from a prospective cohort study of 1293 consecutive general practice attendees (PREDICT-NL), who were followed up after 6 (n = 1236), 12 (n = 1179) and 39 (n = 752) months. We measured the presence and severity of major depressive disorder (MDD) according to DSM-IV criteria and Patient Health Questionnaire 9 (PHQ-9) and mental function with Short Form 12 (SF-12). Recognition of depression was assessed using international classification of primary care codes (P03 and P76) and Anatomical Therapeutic Chemical (N06A) codes from the GP records (6 months before/after baseline). RESULTS: At baseline, 170 (13%) of the participants had MDD, of whom 36% were recognized by their GP. The relative risk of being depressed after 39 months was 1.35 [95% confidence interval (CI) 0.7-2.7] for participants with recognized depression compared to unrecognized depression. At baseline, participants with recognized depression had more depressive symptoms (mean difference PHQ-9 2.7, 95% CI 1.6-3.9) and worse mental function (mean difference mental component summary -3.8, 95% CI -7.8 to 0.2) than unrecognized depressed participants. After 12 and 39 months, mean scores for both groups did not differ but were worse than those without depression. CONCLUSIONS: A minority of patients with MDD is recognized in primary care. Those who were unrecognized had comparable outcome after 12 and 39 months as participants with recognized depression.

The association of depression with cardiovascular mortality is partly explained by health status. The FINE Study.

BACKGROUND: Depression is associated with an increased risk of cardiovascular diseases (CVD) and cardiovascular mortality. We investigated to what extent subjective health status explained the apparent association between depressive symptoms and cardiovascular mortality in older European men. METHODS: Data were used from the population-based prospective Finland, Italy and the Netherlands Elderly (FINE) Study. Depressive symptoms were measured with the Zung Self-rating Depression Scale in 909 men, aged 70-90 years, free of CVD and diabetes in 1990. Subjective health status was estimated with a single question on self-rated health and with a standardized questionnaire about activities of daily living. Cardiovascular mortality was determined during ten years of follow-up. RESULTS: At baseline, poor self-rated health and more disability in activities of daily living were both associated with more depressive symptoms using multiple linear regression analysis. Prospectively men who reported to be unhealthy or with moderate to severe disability had an approximately 2.5 times higher risk of cardiovascular mortality using Cox regression analysis. An increase in depressive symptoms by one standard deviation was associated with an increased risk of cardiovascular mortality (HR 1.37; 95% CI 1.21-1.56). A substantial part of this association was explained by self-rated health and disability (proportion explained 0.32; 95% CI 0.09-0.55). However, a significant risk of depressive symptoms on cardiovascular mortality remained (HR 1.25; 95% CI 1.09-1.43) after adjustment for subjective health status. LIMITATIONS: Health status is based on subjective measures. CONCLUSIONS: In older men, subjective health status explains a considerable part of the association between depression and risk of cardiovascular mortality.

Autonomic dysfunction: a link between depression and cardiovascular mortality? The FINE Study.

BACKGROUND: Depression is associated with an increased risk of cardiovascular diseases (CVD) in vascular patients as well as in the general population. We investigated whether autonomic dysfunction could explain this relationship. DESIGN: The Finland, Italy and The Netherlands Elderly (FINE) Study is a prospective cohort study. METHODS: Depressive symptoms were measured with the Zung Self-rating Depression Scale in 870 men, aged 70-90 years, free of CVD and diabetes in 1990. Resting heart rate was determined from a 15-30-s resting electrocardiogram in The Netherlands and Italy and as pulse rate in Finland. In addition, in The Netherlands, heart-rate variability (HRV) and QTc interval were determined. RESULTS: At baseline, depressive symptoms were associated with an increase in resting heart rate, and nonsignificantly with low HRV and prolonged QTc interval. After 10 years of follow-up, 233 (27%) men died from CVD. Prospectively, an increase in resting heart rate with 1 SD was associated with an increased risk of cardiovascular mortality [hazard ratio (HR), 1.22; 95% confidence interval (CI), 1.08-1.38]. In addition, low HRV (HR, 0.78; 95% CI, 0.61-1.01) and prolonged QTc interval (HR, 1.28; 95% CI, 1.06-1.53) per SD were associated with cardiovascular mortality. The increased risk of depressive symptoms for cardiovascular mortality (HR, 1.38; 95% CI, 1.21-1.58) did not change after adjustments for several indicators of autonomic dysfunction. CONCLUSION: This study suggests that mild depressive symptoms are associated with autonomic dysfunction in elderly men. The increased risk of cardiovascular mortality with increasing magnitude of depressive symptoms could, however, not be explained by autonomic dysfunction.

Physical inactivity, depression, and risk of cardiovascular mortality.

PURPOSE: Studies indicate that depression may increase risk of cardiovascular disease (CVD) in addition to classical risk factors. One of the hypotheses to explain this relation is that depressed subjects become physically inactive. We set out to determine the role of physical inactivity in the relation between depressive symptoms and cardiovascular mortality. METHODS: Data were used from the population-based prospective Finland, Italy, and the Netherlands Elderly (FINE) Study. Depressive symptoms were measured with the Zung Self-Rating Depression Scale in 909 elderly men, aged 70-90 yr, free of CVD and diabetes at baseline in 1990. Physical activity was assessed with a questionnaire for retired men. Hazard ratios (HR) for 10-yr cardiovascular mortality were calculated, adjusting for demographics and cardiovascular risk factors. RESULTS: At baseline, men with more depressive symptoms were less physically active (722 min.wk; 95% confidence interval (CI), 642-802) than men with few depressive symptoms (919 min.wk; 95% CI, 823-1015). During 10 yr of follow-up, 256 (28%) men died from CVD. The adjusted HR of cardiovascular mortality for a decrease of 30 min.d in physical activity was 1.09 (95% CI, 1.04-1.14). An increase in depressive symptoms with one standard deviation was associated with a higher cardiovascular mortality risk (HR = 1.42; 95% CI, 1.26-1.60). After additional adjustment for physical activity the risk decreased (9%), but an independent risk remained (HR = 1.37; 95% CI, 1.21-1.56). The excess risk on cardiovascular mortality attributable to the combined effect of depressive symptoms with inactivity was 1.47 (95% CI, -0.17 to 3.11). CONCLUSIONS: In the present study, the increased risk of depressive symptoms on cardiovascular mortality could not be explained by physical inactivity. However, our results suggest that depressive symptoms and physical inactivity may interact to increase cardiovascular mortality risk.

Depression and cardiovascular mortality: a role for n-3 fatty acids?

BACKGROUND: Recent studies indicate that depression plays an important role in the occurrence of cardiovascular diseases (CVDs). The underlying mechanisms are not well understood. OBJECTIVE: We investigated whether dietary intake of the n-3 fatty acids (FAs) eicosapentaenic acid and docosahexaenoic acid could explain the relation between depressive symptoms and cardiovascular mortality. DESIGN: The Zutphen Elderly Study is a prospective cohort study conducted in the Netherlands. Depressive symptoms were measured in 1990 with the Zung Self-rating Depression Scale in 332 men aged 70-90 y and free from CVD and diabetes. Dietary factors were assessed with a cross-check dietary history method in 1990. Mortality data were collected between 1990 and 2000. Logistic and Cox regression analyses were performed, with adjustment for demographics and CVD risk factors. RESULTS: Compared with a low intake (x: 21 mg/d), a high intake (x: 407 mg/d) of n-3 FAs was associated with fewer depressive symptoms [odds ratio: 0.46; 95% CI: 0.22, 0.95; P for trend = 0.04] at baseline and no significant reduced risk of 10-y CVD mortality [hazard ratio (HR): 0.88; 95% CI: 0.51, 1.50]. The adjusted HR for an increase in depressive symptoms with 1 SD for CVD mortality was 1.28 (95% CI: 1.03, 1.57) and did not change after additional adjustment for the intake of n-3 FAs. CONCLUSION: An average intake of approximately 400 mg n-3 FA/d may reduce the risk of depression. Our results, however, do not support the hypothesis that the intake of n-3 FAs explains the relation between depression and CVD.

Non-transferrin-bound iron and risk of coronary heart disease in postmenopausal women.

BACKGROUND: Epidemiological studies aimed at correlating coronary heart disease (CHD) with serum ferritin levels have thus far yielded inconsistent results. We hypothesized that a labile iron component associated with non-transferrin-bound iron (NTBI) that appears in individuals with overt or cryptic iron overload might be more suitable for establishing correlations with CHD. METHODS AND RESULTS: We investigated the relation of NTBI, serum iron, transferrin saturation, and serum ferritin with risk of CHD and acute myocardial infarction (AMI). The cohort used comprised a population-based sample of 11 471 postmenopausal women aged 49 to 70 years at enrollment in 1993 to 1997. During a median follow-up of 4.3 years (quartile limits Q1 to Q3: 3.3 to 5.4), 185 CHD events were identified, including 66 AMI events. We conducted a case-cohort study using all CHD cases and a random sample from the baseline cohort (n=1134). A weighted Cox proportional hazards model was used to estimate hazard ratios for tertiles of iron variables in relation to CHD and AMI. Adjusted hazard ratios of women in the highest NTBI tertile (range 0.38 to 3.51) compared with the lowest (range -2.06 to -0.32) were 0.84 (95% confidence interval 0.61 to 1.16) for CHD and 0.47 (95% confidence interval 0.31 to 0.71) for AMI. The results were similar for serum iron, transferrin saturation, and serum ferritin. CONCLUSIONS: Our results show no excess risk of CHD or AMI within the highest NTBI tertile compared with the lowest but rather seem to demonstrate a decreased risk. Additional studies are warranted to confirm our findings.

Depressive symptoms as risk factor of cardiovascular mortality in older European men: the Finland, Italy and Netherlands Elderly (FINE) study.

BACKGROUND: Depressive symptoms have been suggested to increase the risk of cardiovascular diseases, but this may reflect reversed causality. We investigated to what extent depressive symptoms are a true risk factor for cardiovascular mortality in elderly men. DESIGN: The Finland, Italy and Netherlands Elderly (FINE) study is a prospective cohort study conducted in Finland, Italy and The Netherlands. METHODS: Depressive symptoms were measured with the Zung self-rating Depression Scale in 799 elderly men, aged 70-90 years, free from cardiovascular diseases. Using Cox models, hazard ratios (HRs) were calculated for specific cardiovascular mortality endpoints. The analyses were adjusted for potential confounders, stratified on country and repeated after exclusion of men who died from cardiovascular diseases up to 5 years after baseline. RESULTS: During 10-years of follow-up 224 (28%) men died from cardiovascular diseases. The adjusted hazard for a five-point increase in depressive symptoms was 1.15 [95% confidence interval (CI) 1.08-1.23] for cardiovascular mortality. This risk was stronger for mortality from stroke (HR 1.35; 95% CI 1.19-1.53) and heart failure (HR 1.16; 95% CI 1.00-1.35) in comparison with mortality from coronary heart disease (HR 1.08; 95% CI 0.97-1.20) and other degenerative heart diseases (HR 1.06; 95% CI 0.91-1.23). Exclusion of men who died from cardiovascular diseases within 5 years after baseline did not change the strength of the associations. There were no significant differences in HRs between northern and southern Europe. CONCLUSIONS: This study provides further and more convincing prospective evidence for depressive symptoms as a risk factor for cardiovascular mortality in elderly men.

Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study.

BACKGROUND: Dispositional optimism, defined in terms of life engagement and generalized positive outcome expectancies for one's future, may be related to lower cardiovascular mortality. We aimed to determine whether dispositional optimism is a stable trait over time and whether it is independently related to lower cardiovascular mortality in elderly men. METHODS: In a cohort study with a follow-up of 15 years, we included 545 (61.4%) of 887 men, aged 64 to 84 years, who were free of preexisting cardiovascular disease and cancer and who had complete data on cardiovascular risk factors and sociodemographic characteristics. Dispositional optimism was assessed using a 4-item questionnaire in 1985, 1990, 1995, and 2000. In Cox proportional hazards models, the first 2 years of observation were excluded. RESULTS: Optimism scores significantly decreased over 15 years, but showed temporal stability (reliability coefficients, 0.72 over 5 years and 0.78 over 15 years; P < .001). Optimists in 1985 had a hazard ratio for cardiovascular mortality of 0.45 (top tertile vs lowest tertile; 95% confidence interval, 0.29-0.68), adjusted for classic cardiovascular risk factors. The risk of cardiovascular death was inversely associated with increased tertiles of dispositional optimism (P < .001 for trend). Similar results were obtained using 1990 data after additional adjustment for depression (assessed by the Zung Self-rating Depression Scale). CONCLUSION: Dispositional optimism is a relatively stable trait over 15 years and shows a graded and inverse association with the risk of cardiovascular death.