Predictive value of baseline cognitive functioning on health-related quality of life in individuals with coronary artery disease: a 5-year longitudinal study.

AIMS: Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Our study aimed to investigate the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) in individuals with CAD with specification to Type D personality traits and sex. METHODS AND RESULTS: This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0% men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every 6 months for up to 2 years, and after 5 years. Cognitive functioning correlated with HRQoL at all time intervals over the 5-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of 5 years. Men participants with characteristics of Type D personality were especially vulnerable to impaired cognitive functioning affecting the 5-year quality of life. CONCLUSION: Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.

Assessment and detection of depression in patients with coronary artery disease: validation of the Persian version of the PHQ-9.

Background: Depression is a common comorbidity in patients with coronary artery disease (CAD), which often remains undetected and untreated. Objective: This study aimed to examine the psychometric properties of the Depression Module of the Patient Health Questionnaire (PHQ-9) on a sample of cardiac patients in Iran. Method: The Persian version of the PHQ-9 was developed and administered to 150 patients with CAD, admitted to a tertiary hospital in Tehran, Iran. The major depression module of the International Neuropsychiatric Interview (MINI) was used as the gold standard for the diagnosis of depression. Results: The Persian PHQ-9 demonstrated acceptable internal consistency, with Cronbach's alpha coefficient of 0.80. The optimal cut-off score of ≥7 showed a sensitivity of 76, specificity of 78, and the area under curve of 0.82. Conclusion: The Persian PHQ-9 has acceptable psychometric properties to screen for and detect a current depressive episode in patients with CAD, with recommended cut-off score of ≥7.

Comorbidity burden in systemic sclerosis: beyond disease-specific complications.

Systemic sclerosis (SSc) is a chronic, systemic disease characterized by fibrosis of the skin and internal organs, vasculopathy, and auto-immune activation. On the top of severe organ involvement such as interstitial lung and myocardial fibrosis, pulmonary hypertension, and renal crisis, individuals diagnosed with SSc may suffer from a number of comorbidities. This is a narrative review according to published recommendations and we searched the online databases MEDLINE and EMBASE using as key words the following terms: systemic sclerosis, scleroderma, myocardial fibrosis in combination with micro- and macro-vascular disease, cardiac involvement, atherosclerosis, cardiovascular disease and coronary arteries, infections, cancer, depression, osteoporosis, and dyslipidemia. Although data are usually inconclusive it appears that comorbidities with significant impact on life expectancy, namely cardiovascular disease, infections, and cancer as well as phycological disorders affecting emotional and mental health are highly prevalent in SSc population. Thereafter, the aim of this review is to summarize the occurrence and the clinical significance of such comorbidities in SSc population and to discuss how rheumatologists can incorporate the management of these conditions in daily clinical practice.

Cost-effectiveness of coronary artery bypass graft and percutaneous coronary intervention compared to medical therapy in patients with coronary artery disease: a systematic review.

Coronary artery disease (CAD) has significant social and economic implications. It is necessary to create tools to identify the most cost-effectiveness treatments, which can assist clinicians in their therapeutic decisions so that the maximum possible benefit is reached with the lowest possible cost. Effectiveness must be measured by final treatment goals in which the most effective interventions are those with the lowest costs. This study is aimed to systematically review and compare the studies conducted on the cost-effectiveness of the three coronary artery disease treatment strategies (medical treatment, percutaneous coronary intervention, and coronary artery bypass graft). In this systematic review, the databases NHS Economic Evaluation Database, Embase, MEDLINE, Science Direct, and Scopus were searched for studies on the cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) compared to medical therapy (MT) in patients with coronary artery disease between 1 January 2004 to 30 September 2018. The quality appraisal of the included studies was examined using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) statement. Out of 186 unique retrievals, 8 studies were included. The results showed that the all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, in most of the studies, quality-adjusted life years (QALY) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($212,800) for PCI v MT and the lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the result of the present study, it seems that each three treatment strategies for CAD yielded improvements in QALY.

Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis.

To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.

Longitudinal Associations of Cigarette Prices With Smoking Cessation: The Coronary Artery Risk Development in Young Adults Study.

INTRODUCTION: Few studies have used longitudinal cohort data to examine associations of cigarette prices with smoking cessation or whether price sensitivity varies by income or education. This study examines these associations in a multicenter US cohort and explores whether associations vary by education and income. METHODS: Longitudinal data from baseline daily cigarette smokers aged 18-30 years in the Coronary Artery Risk Development in Young Adults study were linked to inflation-adjusted cigarette carton prices from the Council for Community and Economic Research Cost of Living Index based on residential address at baseline and in years 7, 10, and 15 (1985-2001). Multivariable Cox models estimated hazard ratios (HRs) of first (any) smoking cessation and sustained smoking cessation (no relapse) associated with each $1 increase in time-dependent cigarette price over 15 years of follow-up. Models were adjusted for sociodemographic, health-related, and policy covariates. We assessed effect modification by education and household income. RESULTS: Among 1489 participants, a $1.00 higher cigarette carton price was associated with a 16% higher likelihood of first smoking cessation (HR = 1.16, 95% CI = 1.11 to 1.21) and an 8% higher likelihood of sustained smoking cessation (HR = 1.08, 95% CI = 1.02 to 1.14). Associations were strongest among participants with lower income for first cessation, and among those with higher income for sustained cessation. Associations were strongest for participants with less than a high school degree for both outcomes. CONCLUSIONS: Results suggest higher cigarette prices promote smoking cessation among young to middle-aged adults, and that price sensitivity may differ by socioeconomic status. IMPLICATIONS: Few studies have examined longitudinal associations of cigarette prices with smoking cessation, and findings are mixed on whether price sensitivity varies by education or income. In a cohort of US adult daily smokers, cigarette prices were associated with greater likelihood of both a first cessation and sustained cessation. Price associations with first cessation were stronger among low-income smokers, but associations with sustained cessation were stronger among high-income smokers. Results suggest that although higher cigarette prices may promote short-term smoking cessation among smokers at all income levels, additional supports may be needed to facilitate sustained smoking cessation among low-income smokers.

Socioeconomic factors in coronary artery disease - Results from the SPIRR-CAD study.

Low socio-economic status (SES) has been associated with an increased coronary risk in Western countries. All stress experiences are more pronounced in low SES patients with stress emanating from problems with family, job, or money. The SPIRR-CAD study offered an excellent opportunity to examine these risk factors in German speaking mildly and medium depressed patients. In the SPIRR CAD study, a German multi centre randomized clinical trial of 450 male and 120 female coronary patients, we examined the standard and psychosocial risk factor profiles in relation to SES, as assessed by educational level. All differences in risk factors between low and high SES were in the inverse direction. Of standard risk factors, only smoking was socially graded and more common in low SES. Of psychosocial factors and emotions, exhaustion showed the strongest and most consistent inverse social gradient, but also anger, anxiety and depression were socially graded. The findings suggest that in German patients, as in other national groups, social gradients in CHD risk are considerable. They can be ascribed to both psychosocial and to standard risk factors. In the present two years follow-up, the prospective significance of psychological and social risk factors was analyzed showing that emotional factors played an important role, in that low and high SES patients differed in the expected direction. However, the differences were not statistically significant and therefore firm conclusions from follow up were not possible. TRIAL REGISTRATION: ISRCTN 76240576; NCT00705965.

Long-term clinical outcomes, health-related quality of life, and costs in different treatment modalities of stable coronary artery disease.

Aims: This study is a prospective, observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002-03. Recorded were clinical outcomes, health-related quality of life (HRQoL), and secondary care costs after coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), or medical therapy (MT). Methods and results: HRQoL was measured by the 15D instrument at baseline, 6 months, and 8 years. Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups. At baseline, all groups had statistically significantly impaired HRQoL compared with age- and gender-standardized general population. Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinically important manner. This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population, whereas MT patients were still worse off. However, after adjustment for baseline characteristics, the groups no longer differed regarding 8-year survival or change in HRQoL among survivors. Mean 8-year secondary care costs were without (with) adjustment for baseline characteristics: €17 498 (16 730) for CABG, €7245 (6920) for PCI, and €4514 (4580) for MT, respectively. Conclusion: When adjusted for baseline characteristics, no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors. The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold, even after adjustment for baseline characteristics, compared with those of PCI and MT.

Assessment of the association between the personality traits of young patients with acute coronary syndrome and the severity of coronary artery disease.

OBJECTIVE: The role of psychosocial risk factors is becoming increasingly important in the etiology of acute coronary syndrome (ACS). The purpose of this study was to assess an association between the personality types of young patients with ACS and the prevalence and severity of coronary artery disease (CAD). METHODS: Patients younger than 45 years of age who presented with ACS and who underwent coronary angiography in the period from 2012 to 2016 were included in the study. The coronary angiography records of the patients were examined and their Gensini score (GS) was calculated; GS ≥20 was considered to be severe CAD. The Eysenck Personality Questionnaire-Revised Short Form scales were used to measure psychoticism, extraversion, lying, and neuroticism. RESULTS: A total of 139 patients were included in the study. The median psychoticism score of patients with GS <20 was found to be significantly higher than that of patients with GS ≥20 [1.0 (25th and 75th percentile: 0.0-2.0) vs. 1.0 (25th and 75th percentile: 0.0-1.0); p=0.015]. The median psychoticism score was 1.0 (25th and 75th percentile: 1.0-2.0) in the unstable angina pectoris group, 0.5 (25th and 75th percentile: 0.0-1.0) in the ST segment elevation myocardial infarction group, and 1.0 (25th and 75th percentile: 0.0-1.0) in the non-ST segment elevation myocardial infarction group (p=0.004). CONCLUSION: The presence of psychoticism characteristics in patients who present with ACS is associated with less severe CAD.

Predictors of Quality of Life Improvement after 2 Years of Coronary Artery Bypass Surgery.

PURPOSE: The aim was to examine the predictors of improvement of quality of life after 2 years of coronary artery bypass grafting (CABG). METHODS: In all, 208 patients who underwent the elective CABG at the Institute for Cardiovascular Diseases Dedinje in Belgrade were contacted and examined 2 years after the surgery. All patients completed Nottingham Health Profile Questionnaire part one. RESULTS: Two years after CABG, quality of life (QOL) in patients was significantly improved in all sections compared to preoperative period. Independent predictors of QOL improvement after 2 years of CABG were found to be serious angina under sections of physical mobility [p = 0.003, odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.21-2.55], energy (p = 0.01, OR = 1.63, 95% CI: 1.11-2.38), sleep (p = 0.005, OR = 1.65, 95% CI: 1.16-2.35), pain (p <0.001, OR = 2.43, 95% CI: 1.57-3.77), absence of hereditary load in energy section (p = 0.002, OR = 0.35, 95% CI: 0.18-0.68), male sex in the sleep section (p = 0.03, OR = 0.43, 95% CI: 0.20-0.93), and absence of diabetes in pain section (p = 0.006, OR = 0.27, 95% CI: 0.10-0.68). CONCLUSION: Predictors of improvement of QOL after 2 years of CABG are serious angina, absence of hereditary load, male sex, and absence of diabetes.

Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease: Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study.

BACKGROUND: Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population. METHODS AND RESULTS: In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age-decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group. CONCLUSIONS: In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.

Effects of cardiac telerehabilitation in patients with coronary artery disease using a personalised patient-centred web application: protocol for the SmartCare-CAD randomised controlled trial.

BACKGROUND: Cardiac rehabilitation has beneficial effects on morbidity and mortality in patients with coronary artery disease, but is vastly underutilised and short-term improvements are often not sustained. Telerehabilitation has the potential to overcome these barriers, but its superiority has not been convincingly demonstrated yet. This may be due to insufficient focus on behavioural change and development of patients' self-management skills. Moreover, potentially beneficial communication methods, such as internet and video consultation, are rarely used. We hypothesise that, when compared to centre-based cardiac rehabilitation, cardiac telerehabilitation using evidence-based behavioural change strategies, modern communication methods and on-demand coaching will result in improved self-management skills and sustainable behavioural change, which translates to higher physical activity levels in a cost-effective way. METHODS: This randomised controlled trial compares cardiac telerehabilitation with centre-based cardiac rehabilitation in patients with coronary artery disease. We randomise 300 patients entering cardiac rehabilitation to centre-based cardiac rehabilitation (control group) or cardiac telerehabilitation (intervention group). The core component of the intervention is a patient-centred web application, which enables patients to adjust rehabilitation goals, inspect training and physical activity data, share data with other caregivers and to use video consultation. After six supervised training sessions, the intervention group continues exercise training at home, wearing an accelerometer and heart rate monitor. In addition, physical activity levels are assessed by the accelerometer for four days per week. Patients upload training and physical activity data weekly and receive feedback through video consultation once a week. After completion of the rehabilitation programme, on-demand coaching is performed when training adherence or physical activity levels decline with 50% or more. The primary outcome measure is physical activity level, assessed at baseline, three months and twelve months, and is calculated from accelerometer and heart rate data. Secondary outcome measures include physical fitness, quality of life, anxiety and depression, patient empowerment, patient satisfaction and cost-effectiveness. DISCUSSION: This study is one of the first studies evaluating effects and costs of a cardiac telerehabilitation intervention comprising a combination of modern technology and evidence-based behavioural change strategies including relapse prevention. We hypothesise that this intervention has superior effects on exercise behaviour without exceeding the costs of a traditional centre-based intervention. TRIAL REGISTRATION: Netherlands Trial Register NTR5156 . Registered 22 April 2015.

Smoking Cessation in Pulmonary Care Subjects: A Mixed Methods Analysis of Treatment-Seeking Participation and Preferences.

BACKGROUND: African-American smokers experience disproportionate COPD morbidity. As a front-line COPD behavioral management strategy, smoking cessation is less prevalent among African-American smokers. Identifying barriers and predictors to smoking cessation in this population is important to bridging this disparity. METHODS: In this study, the predictors of enrollment and attendance to a 3-session urban hospital smoking cessation program were examined. A retrospective chart review was conducted for all pulmonary clinic patients who smoked and were referred to the cessation program between June 2013 and May 2014. Demographic, smoking behavior, cardiopulmonary, and health status variables were extracted (N = 253). Second, a qualitative assessment of the beliefs and barriers for smoking cessation and physical activity were examined in a sub-sample of the population (n = 41). RESULTS: One-hundred forty-seven of the pulmonary subjects (58%) enrolled in the cessation program, and 40 attended all sessions (16% of the total sample). Participants with COPD (odds ratio = 4.65, P = .030), or had a mother who had cancer (odds ratio = 4.49, P = .027), were more likely to attend the program. Qualitatively, pulmonary care patients who wanted to quit smoking and be more physically active cited: strong beliefs about the inability to engage in these behaviors, belief that quitting and increased activity might exacerbate poor health, and an inability to obtain pharmacotherapy as barriers to adopting these behaviors. CONCLUSIONS: Smoking cessation program attendance in this sample of mostly African-American smokers was poor. Increased knowledge about cessation benefits and access to full-course pharmacotherapy, particularly in those without a COPD diagnosis and who do not have a maternal history of cancer, may be high-priority targets to promote cessation program uptake in this population. Increased knowledge and access to safe forms of physical activity may also be beneficial.

Assessment of the need for psychosomatic care in patients with suspected cardiac disease.

OBJECTIVE: The study aimed to assess the subjectively perceived need for additional general disease-oriented and psychotherapeutic care in patients with suspected cardiac disease and to investigate if the request for additional care is consistent with impairment of generic quality of life and the presence of psychosomatic risk factors. MATERIAL AND METHODS: Patients referred for cardiac stress testing because of suspected cardiac disease completed the assessment of the demand for additional psychological treatment (ADAPT) questionnaire, an assessment tool for counselling demand in patients with chronic illness, the SF-36 quality of life and the hospital anxiety and depression scale (HADS) questionnaires. RESULTS: The questionnaires were administered to 233 patients (age: 54.5 ± 13.4, 57.5 % male). Exclusive demand for disease-oriented counselling was indicated by 45.1 %, demand for psychotherapeutic counselling (exclusive or combined with disease-oriented demand) by 33.9 %. Almost all patients with psychotherapeutic demand (96.3 %) expressed also request for disease-oriented counselling. Patients with exclusive demand for disease-oriented counselling showed significantly lower scores in the emotional and physical functioning and role domains of the SF-36 than the norm population. Patients demanding psychotherapeutic counselling reported significantly lower scores in all SF-36 domains than the norm population. Psychotherapeutic demand was strongly associated with positive indicators for mental distress: SF-36 MH (OR: 4.1), SF-36 MCS (OR: 5.9), HADS anxiety (OR: 3.9), and HADS depression (OR: 3.0). CONCLUSIONS: Our study shows that the patients' request for additional care reflects impairment of generic health status and psychological risk load. This indicates that the assessment of subjectively perceived demand allows to screen for patients who are in need of psychosomatic care and motivated to participate in additional counselling and therapy.

Assessment of 2013 AHA/ACC ASCVD risk scores with behavioral characteristics of an urban cohort in India: Preliminary analysis of Noncommunicable disease Initiatives and Research at AMrita (NIRAM) study.

Cardiovascular diseases (CVDs) are the leading cause of death and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVDs.The aim of this study was to determine the baseline risk of a "hard CVD event" in subjects attending comprehensive health clinic and assess behavioral characteristics in "at risk" population.Using WHO STEPwise approach to Surveillance modified questionnaire, prevalence of noncommunicable diseases (NCDs) and risk factors was estimated in this cross-sectional study of 4507 subjects. Baseline cardiovascular risk was determined using Framingham risk score (FRS) and American College of Cardiology (ACC)/American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) algorithms. Modifiable behavior associated with high CVD risk was assessed. Among 40 to 59-year olds, ASCVD risk tool derived both a 10-year and lifetime risk score, which were used to stratify the cohort into 3 risk groups, namely, a high 10-year and high lifetime, a low 10-year and high lifetime, and a low 10-year and low lifetime risks.Dyslipidemia (30.6%), hypertension (25.5%), diabetes mellitus (20%), and obstructive airway disorders (17.6%) were most prevalent NCDs in our cohort. The ASCVD score stratified 26.1% subjects into high 10-yr and 59.5% into high lifetime risk while FRS classified 17.2% into high 10-year risk. Compared with FRS, the ASCVD risk estimator identified a larger proportion of subjects "at risk" of developing CVD. A high prevalence of alcohol use (38.4%), decreased intake of fruits and vegetables (96.2%) and low physical activity (58%) were observed in "at risk" population. Logistic regression analysis showed that in 40 to 59-year group, regular and occasional drinkers were 8.5- and 3.1-fold more likely to be in high 10-year and high lifetime ASCVD risk category than in low 10-year and low lifetime risk group. Similarly, regular drinkers and occasional drinkers were 2.1 and 1.3 times more likely to be in low 10-year and high lifetime risk than in low 10-year and low lifetime risk category. Subjects with inadequate intake of fruits and vegetables were 1.59 times more likely to be in low 10-year and high lifetime risk than the lower 10-year and lifetime risk group. Obese participants were 2.3-fold more likely to be in low 10-year and high lifetime risk.Identification of "at risk" subjects from seemingly healthy population will allow sustainable primary prevention strategies to reduce CVD.

Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: A Randomized Trial.

BACKGROUND: Increasing use of genetic testing raises questions about disclosing secondary findings, including pleiotropic information. OBJECTIVE: To determine the safety and behavioral effect of disclosing modest associations between apolipoprotein E (APOE) genotype and coronary artery disease (CAD) risk during APOE-based genetic risk assessments for Alzheimer disease (AD). DESIGN: Randomized, multicenter equivalence clinical trial. (ClinicalTrials.gov: NCT00462917). SETTING: 4 teaching hospitals. PARTICIPANTS: 257 asymptomatic adults were enrolled, 69% of whom had 1 AD-affected first-degree relative. INTERVENTION: Disclosure of genetic risk information about AD and CAD (AD+CAD) or AD only (AD-only). MEASUREMENTS: Primary outcomes were Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores at 12 months. Secondary outcomes were all measures at 6 weeks and 6 months and test-related distress and health behavior changes at 12 months. RESULTS: At 12 months, mean BAI scores were 3.5 in both the AD-only and AD+CAD groups (difference, 0.0 [95% CI, -1.0 to 1.0]), and mean CES-D scores were 6.4 and 7.1 in the AD-only and AD+CAD groups, respectively (difference, 0.7 [CI, -1.0 to 2.4]). Both confidence bounds fell within the equivalence margin of ±5 points. Among carriers of the APOE ε4 allele, distress was lower in the AD+CAD groups (difference, -4.8 [CI, -8.6 to -1.0]) (P = 0.031 for the interaction between group and APOE genotype). Participants in the AD+CAD groups also reported more health behavior changes, regardless of APOE genotype. LIMITATIONS: Outcomes were self-reported by volunteers without severe anxiety, severe depression, or cognitive problems. Analyses omitted 33 randomly assigned participants. CONCLUSION: Disclosure of pleiotropic information did not increase anxiety or depression and may have decreased distress among persons at increased risk for 2 conditions. Providing risk modification information about CAD improved health behaviors. Findings highlight the potential benefits of disclosure of secondary genetic findings when options exist for decreasing risk. PRIMARY FUNDING SOURCE: National Human Genome Research Institute.

Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care.

BACKGROUND: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. METHODS: In this cross-sectional study, 586 consecutive DM2/CHD patients aged >18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. RESULTS: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. LIMITATIONS: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. CONCLUSIONS: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression.

[The New European Questionnaire for Assessment of Quality of Life of Patients With Ischemic Heart Disease: HeartQoL].

Quality of life (QL) of patients with ischemic heart disease (IHD) is a combination symptoms of the disease, physical state, emotional status, and social-laboring functioning. Until recently there were no universal questionnaire allowing to perform comparative analysis of QL of patients with effort angina (EF), survivors of myocardial infarction (MI) and chronic heart failure (CHF). Therefore, European Association of Cardiovascular Prevention and Rehabilitation conducted a study with the aim of developing universal questionnaire for assessment of QL in patients with IHD - HeartQol. The study enrolled 6384 patients with angina, MI, or CHF across 22 countries (315 in Russia). Patients completed a battery of questionnaires and Mokken scaling analysis was used to identify most important guestions for assessment of QL questions to be included into the HeartQoL questionnaire.

Depression in people with coronary heart disease: prognostic significance and mechanisms.

Depression affects about 40 % of people with coronary heart disease (CHD). This group with depression and CHD have increased mortality and morbidity, worse health-related quality of life, use health services more frequently and consequently cost the health service and the national economy considerably more than their non-depressed counterparts. A number of characteristics of depression and plausible mechanisms have been proposed to explain this observed association, which could lead to improved understanding of the association and lead to new interventions to improve cardiac outcomes. This review summarises the evidence linking depression with worse cardiac outcomes, considers specific aspects of depression which may predict worse outcomes and reviews the mechanisms that could potentially explain the direct or indirect association of depression with coronary outcomes.