CARDIAC RISK MARKERS AND UNREMITTING DEPRESSION IN ACUTE CORONARY SYNDROME

急性冠脉综合征中的心脏风险标志物和持续抑郁

• 批准号: 8054977
• 负责人: ROBERT M CARNEY
• 金额: $ 74.47万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8054977
• 关键词: Aftercare; Area; Cardiac; Cardiovascular system; Cessation of life; Clinical Trials; Cognitive Therapy; DSM-IV; Depressed mood; Enrollment; Equation; Frequencies; Hamilton Rating Scale for Depression; Health; Hospitalization; Hospitals; Individual; Lead; Link; Literature; Measures; Mediator of activation protein; Medical; Mental Depression; Modeling; Myocardial Infarction; Participant; Patients; Process; Questionnaires; Recruitment Activity; Research; Research Personnel; Resistance; Risk; Risk Factors; Risk Marker; Sampling; Sertraline; Severities; Survival Rate; Testing; Universities; Washington; acute coronary syndrome; cardiovascular risk factor; dosage; effective intervention; high risk; improved; medical schools; meetings; mortality; patient population; response; single episode major depressive disorder; standard care

DESCRIPTION (provided by investigator): Depression is a risk factor for mortality after hospitalization for acute coronary syndrome (ACS). However, converging evidence from several recent clinical trials suggests that the mortality risk is higher among patients with treatment-resistant depression than those who respond to standard treatments for depression. Interestingly, some of the strongest predictors of treatment resistance in depressed psychiatric patients also happen to be cardiac risk markers, including indicators of cardiovascular autonomic dysregulation, HPA axis dysregulation, and proinflammatory and procoagulant processes. Furthermore, these markers have also been identified as potential mediators of the effect of depression on post-ACS mortality. The purpose of this study is to test the hypotheses that 1) depressed post-ACS patients who fail to respond to aggressive treatment for depression have higher levels of specific cardiac risk markers at the end of treatment than do otherwise comparable patients who do respond; 2) high levels of these cardiac risk markers prior to treatment predict poor response to depression treatment; and 3) these risk markers improve as depression improves in treatment responders. Participants will be recruited from three St. Louis area hospitals affiliated with Washington University School of Medicine. One hundred seventy patients, who meet the DSM-IV criteria for a current major depressive episode and who score 17 or higher on the HAM-D-17 approximately 3 months after hospitalization for ACS, will be enrolled in the study. All participants will be treated with individual cognitive behavior therapy (CBT) for up to 6 months. The frequency of CBT sessions will decrease when specific improvement criteria are met. Patients who have not improved >50 percent on the BDI-II depression questionnaire by 3 months will continue in CBT but will also be given sertraline at an initial dosage of 50 mg/day. If necessary and if tolerated, the dosage will be gradually increased to a maximum of 200 mg/day. Depression will be assessed, and cardiac risk markers will be measured, at baseline, 3 months, and 6 months. Structural equation models will be used to test the primary hypotheses. Relevance: Depression doubles the risk of death after a heart attack, for reasons that are not well understood. Initial efforts to reduce this risk by treating depression have not been successful. This study will help to clarify how depression increases the risk of dying, and it may suggest ways to develop more effective interventions. PUBLIC HEALTH RELEVANCE: Depression doubles the risk of death after a heart attack, for reasons that are not well understood. Initial efforts to reduce this risk by treating depression have not been successful. This study will help to clarify how depression increases the risk of dying, and it may suggest ways to develop more effective interventions.

描述（由研究人员提供）：抑郁是急性冠状动脉综合征（ACS）住院后死亡率的危险因素。但是，来自最近的几项临床试验的融合证据表明，耐药抑郁症患者的死亡率风险比对抑郁症的标准治疗方法的抑郁症患者高。有趣的是，抑郁症患者中一些最强的治疗耐药性预测指标也恰好是心脏危险标志物，包括心血管自主性失调，HPA轴轴的指标，HPA轴功能障碍以及促炎和促凝过程。此外，这些标记也已被确定为抑郁症对ACS后死亡率作用的潜在介体。这项研究的目的是检验假设：1）在治疗结束时对抑郁症的抑郁后ACS患者的抑郁症患者的特定心脏危险标记水平高于其他反应的患者； 2）在治疗之前，这些心脏危险标志物的高水平预测对抑郁症治疗的反应不佳； 3）随着治疗响应者的抑郁症的改善，这些风险标记会有所改善。参与者将从华盛顿大学医学院隶属的三家圣路易斯地区医院招募。这项研究将纳入研究中，符合当前重大抑郁发作的DSM-IV标准，在ACS住院后约3个月对HAM-D-17分17或更高的一百七十名患者将纳入研究。所有参与者将在长达6个月内接受个人认知行为疗法（CBT）的治疗。当满足特定改进标准时，CBT会话的频率将减少。在CBT中，未在BDI-II抑郁症问卷提高3个月的50％> 50％的患者将继续以50 mg/天的初始剂量给予舍曲林。如有必要，如果容忍，剂量将逐渐增加到最大200 mg/天。将评估抑郁症，并在基线，3个月和6个月时测量心脏风险标记。结构方程模型将用于测试主要假设。相关性：出于无法理解的原因，抑郁症使心脏病发作后死亡的风险增加一倍。通过治疗抑郁症来降低这种风险的最初努力尚未成功。这项研究将有助于阐明抑郁症如何增加死亡的风险，并可能提出开发更有效干预措施的方法。公共卫生相关性：出于无法理解的原因，抑郁症使心脏病发作后死亡的风险增加一倍。通过治疗抑郁症来降低这种风险的最初努力尚未成功。这项研究将有助于阐明抑郁症如何增加死亡的风险，并可能提出开发更有效干预措施的方法。