Abstract
Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006–2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1unit increase in CES-D was associated with 4% higher odds (95% CI 1.008–1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence.
Highlights
Depression has been recognized as an independent predictor for the development of coronary heart disease (CHD) among healthy and, especially, elderly individuals
In patients recovering from an acute coronary syndrome (ACS), even the presence of mildly elevated depressive symptoms is associated with a worse prognosis [2]
Patients in the upper tertile of the Center of Epidemiological Studies-Depression scale (CES-D) scale (i.e., >18) had higher incidence of 30-day cardiovascular disease (CVD) events as compared with those in the lowest tertile (21% versus 8%, P = .01); in addition they were more likely to be females (48% versus 10%, P = .001), they had higher prevalence of hypertension (88% versus 63%, P = .05) and lower current smoking habits (27% versus 20%, P = .05), while no difference was observed according to diabetes mellitus history, physical activity status, dietary habits, Body mass index (BMI), left ventricular ejection fraction, and previous history of CVD
Summary
Depression has been recognized as an independent predictor for the development of coronary heart disease (CHD) among healthy and, especially, elderly individuals. During the past 30 years, several observational studies and clinical trials have provided scientific evidence that the Mediterranean diet is associated with decreased all-cause mortality and improvements in cardiovascular risk factors levels [5, 6]. From the late 1960s, Keys and his colleagues from the Seven Countries study underlined the effect of the dietary habits observed in Mediterranean populations on cardiovascular disease risk [7]. De Lorgeril et al, from the Lyon Heart Study, that was a randomized secondary prevention clinical trial of CHD patients, revealed the protective effect of this traditional dietary pattern on cardiac
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