Abstract
Aim . To assess the significance of psychosocial factors, anxiety and depressive disorders in predicting the comorbidities in patients with coronary artery disease (CAD). Material and methods . The study included 132 patients aged 37 to 66 years with CAD and anxiety-depressive disorders. Depression was found in 42% of patients, anxiety — in 25%; combination of anxiety, depression — in 33%. The assessment of the significance of cardiovascular and psychosocial factors in predicting comorbidities in patients with CAD was carried out using the logistic regression. Results . The total prognosis percentage was 95,4% in the general group of patients (Somers'D — 0,910). In the group of men, it was 95,5% (Somers'D -0,912); in the group of women — 93,1% (Somers'D — 0,877). The predictors with a high significance level (p=0,0001) were following cardiovascular risk factors: patient age, hypertension, diabetes, dyslipidemia, left ventricular hypertrophy, arrhythmias, smoking, positive family history of cardiovascular diseases and others. Following psychosocial factors were also significant: stress and characteristics of stressors, active psychopathological syndrome with leading anxiety and/or depressive symptoms, the patient age at the onset of mental disorder diagnosis, duration of the mental disorder, and psychological characteristics of patients. The age of the mental disorder onset was found to be related to the previous stressful events (p=0,0001). A relationship was found between the age of patients with the onset of mental disorder and the severity of CAD (p=0,0001), as well as with the age of CAD onset and the sex of patients (p=0,0007). The contribution of stressful events before anxiety and depressive disorders to the development of predictors effecting the course and diagnosis of CAD was shown. Conclusion . Logistic regression showed a relevant relationship of cardiovascular risk factors, psychosocial factors, anxiety and depressive disorders, included in the list of significant predictors of comorbidities and the progression of CAD. The results obtained serve as a guideline for an interdisciplinary approach to the treatment and prevention of comorbidities.
Highlights
АГ — артериальная гипертония, гипертрофии левого желудочка (ГЛЖ) — гипертрофия левого желудочка, ДЛП — дислипидемия, ишемической болезнью сердца (ИБС) — ишемическая болезнь сердца, НРС — нарушения ритма сердца, нарушением толерантности к глю‐ козе (НТГ) — нарушение толерантности к глюкозе, сахарным диабетом (СД) — сахарный диабет, сердечнососудистых заболеваний (ССЗ) — сердечно-сосудистые заболевания, сосудистый риск (ССР) — сердечно-сосудис тый риск
Depression was found in 42% of patients, anxiety — in 25%; combination of anxiety, depression — in 33%
A relationship was found between the age of patients with the onset of mental disorder and the severity of coronary artery disease (CAD) (p=0,0001), as well as with the age of CAD onset and the sex of patients (p=0,0007)
Summary
A relationship was found between the age of patients with the onset of mental disorder and the severity of CAD (p=0,0001), as well as with the age of CAD onset and the sex of patients (p=0,0007). Понятие “психосоциальные факторы” включает широкий спектр психических и поведенческих расстройств, социаль‐ ных факторов и психологических особенностей лич‐ ности, повышающих риск возникновения сердечнососудистых заболеваний (ССЗ) и осложнений, ухуд‐ шающих прогноз и выживаемость пациентов с ишемической болезнью сердца (ИБС), вместе с тем за трудняющих клинику, диагностику, лечение, профи‐ лактику ССЗ и коморбидных состояний [2, 3]. Что современные Рекомен‐ дации по изучению соотношений сердечно-сосудис тых и психосоциальных факторов помогают врачам терапевтам и кардиологам в приобретении опыта и навыков выявления, оценки и интерпретации сим‐ птомов психической и психологической дезадапта‐ ции, а также освоению компетенций по вопросам диагностики, лечения и коррекции коморбидных состояний у пациентов с ССЗ [9, 10]. Цель исследования — оценить значимость психо‐ социальных факторов, тревожных и депрессивных расстройств при прогнозировании особенностей комор‐ бидных состояний у пациентов с ИБС.
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