Physical Activity, Depression, and Post-ACS Survival

体力活动、抑郁和 ACS 后生存

基本信息

批准号：
7935569
负责人：
JOSEPH E. SCHWARTZ
金额：
$ 19.97万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7935569
关键词：
Accounting Aerobic Age Ancillary Study Arousal Behavioral Biological Cardiac Chronic Clinical Clinical Trials Cohort Studies Data Diagnosis Dose Elements Endogenous depression Enrollment Event Exercise Future Gender Guidelines Heart Heart Diseases Hospitalization Hospitals Intervention Interview Knowledge Link Major Depressive Disorder Measures Mediating Mediator of activation protein Modeling Monitor Outcome Parents Pathogenicity Pathway interactions Patient Self-Report Patients Physical activity Platelet aggregation Population Prognostic Factor Public Health Risk Risk Factors Role Severities Severity of illness Sleep Smoking Status Structure Testing Time Treadmill Tests actigraphy acute coronary syndrome awake base biobehavior cardiac depression cohort depressed depression depressive symptoms design experience hazard improved inflammatory marker innovation medication compliance mortality patient population programs public health relevance sedentary single episode major depressive disorder

Accounting Aerobic Age Ancillary Study Arousal Behavioral Biological Cardiac Chronic Clinical Clinical Trials Cohort Studies Data Diagnosis Dose Elements Endogenous depression Enrollment Event Exercise Future Gender Guidelines Heart Heart Diseases Hospitalization Hospitals Intervention Interview Knowledge Link Major Depressive Disorder Measures Mediating Mediator of activation protein Modeling Monitor Outcome Parents Pathogenicity Pathway interactions Patient Self-Report Patients Physical activity Platelet aggregation Population Prognostic Factor Public Health Risk Risk Factors Role Severities Severity of illness Sleep Smoking Status Structure Testing Time Treadmill Tests actigraphy acute coronary syndrome awake base biobehavior cardiac depression cohort depressed depression depressive symptoms design experience hazard improved inflammatory marker innovation medication compliance mortality patient population programs public health relevance sedentary single episode major depressive disorder

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项目摘要

DESCRIPTION (provided by applicant): The association of depression status and severity to 1-year major adverse cardiac events (MACE) and allcause mortality (ACM) after acute coronary syndrome (ACS) is strong and independent of other known risk factors. However, our understanding of the mechanisms underlying this association remains limited. This proposed ancillary study will build on our parent program project, Depression, Biobehavioral Mechanisms, & CHD/Mortality Outcomes. The parent study tests medication adherence, platelet aggregation, and inflammatory markers as possible mechanisms explaining depression's excess MACE/ACM risk. However, recent, exciting findings suggest that depressed, stable cardiac patients' excess MACE/ACM risk is largely explained by less physical activity. This mechanism is not being tested in the parent study. We propose adding an objective, continuous, 90-day assessment of physical activity, using actigraphy, to a new cohort study of 1400 patients enrolled in hospital at the time of an ACS event. This, in combination with the structured interview diagnosis of clinical depression, the assessments of depressive symptoms and selfreported physical activity, and the 12-month tracking of all subjects for MACE/ACM that are already included in the parent study, will enable us to test the hypothesis that physical (in)activity mediates the relationship between depression and cardiac outcome risk. The addition of actigraphy to the parent study is time-sensitive, as we cannot collect these data retrospectively. The parent study benefits by adding one more mechanism to be explored. If confirmed, this will extend the generalizability of the recent findings of stable cardiac patients to a post-ACS population. Specifically, we will test that:1) Patients who are depressed peri-ACS engage in less physical activity during the subsequent 3 months; 2) Lower levels of physical activity during the 3 months post-discharge are associated with increased risk for MACE/ACM during the subsequent 9 months; and 3) The independent association between depression and MACE/ACM is substantially reduced when physical activity is statistically controlled, supporting the role of physical activity as a mediator. Innovation: Having ACS patients steadily increase their physical activity after hospital discharge is a major component of treatment guidelines; to our knowledge, this will be the first study to use actigraphy to continuously monitor physical activity for an extended period following hospital discharge. PUBLIC HEALTH RELEVANCE: Physical activity post-ACS is modifiable, and its lack is a huge public health problem in its own right. If depressed patients are less physically active by objective assessment following ACS hospitalization, and this explains a substantial portion of their excess risk, we will have foundational observational data to propose an exercise intervention in this patient population.

描述（由申请人提供）：急性冠状动脉综合征（ACS）之后，抑郁状态和严重程度与1年重大不良心脏事件（MACE）和全因死亡率（ACM）的关联是强大的，并且与其他已知危险因素无关。但是，我们对这种关联基础机制的理解仍然有限。这项拟议的辅助研究将建立在我们的家长计划项目，抑郁，生物行为机制和冠心病/死亡率结果的基础上。父母研究测试药物依从性，血小板聚集和炎症标记，可能是解释抑郁症过多的MACE/ACM风险的可能机制。然而，最近令人兴奋的发现表明，抑郁，稳定的心脏患者的过量狼牙棒/ACM风险在很大程度上通过体育锻炼较少来解释。在父母的研究中，该机制尚未测试。我们建议使用Actigraphy对体育活动的客观，连续的，90天的评估，对ACS事件发生时入院的1400名患者进行新的队列研究。这与对临床抑郁症的结构化访谈诊断，抑郁症状和自我报告的体育活动的评估以及对父母研究中已经包括的所有MACE/ACM的所有受试者的12个月跟踪，将使我们能够测试身体（IN）活动的假设，即抑郁症和心脏结束风险之间的关系介导了抑郁症的关系。在父母研究中添加Attraphy是时间敏感的，因为我们无法追溯收集这些数据。家长研究通过添加另一种要探索的机制来受益。如果得到证实，这将把稳定心脏患者最近发现的普遍性扩展到后ACS人群。具体来说，我们将测试：1）在随后的3个月内，肌肉痛的患者从事体育锻炼较少的患者； 2）入院后3个月内的体育锻炼水平较低与随后9个月内MACE/ACM的风险增加有关； 3）当体育活动受到统计控制时，抑郁与MACE/ACM之间的独立关联大大降低，从而支持体育活动作为介体的作用。创新：让ACS患者在出院后稳步增加其体育活动是治疗指南的主要组成部分；据我们所知，这将是第一项使用Actraphy在医院出院后长时间不断监测体育活动的研究。公共卫生相关性：ACS后体育活动可修改，其缺乏本身就是一个巨大的公共卫生问题。如果ACS住院后，通过客观评估，抑郁症患者的身体活动较低，这解释了其大部分过剩风险，我们将拥有基本的观察数据，以对该患者人群进行运动干预。