ArticleJournal of the American College of Cardiology2013
Behavioral mechanisms, elevated depressive symptoms, and the risk for myocardial infarction or death in individuals with coronary heart disease: the REGARDS (Reason for Geographic and Racial Differences in Stroke) study.
Article in Journal of the American College of Cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.
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Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it, 100 citations in OpenAlex.
- Cardiovascular diseases and depression: A meta-analysis and Mendelian randomization analysis.Molecular psychiatry · 2025Pooled it
- Trial
- Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans.Journal of clinical hypertension (Greenwich, Conn.) · 2019Trial
- Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes.The American journal of medicine · 2014Trial
- Trial
- Article
- Implementing depression treatment for cardiac populations in rapidly changing contexts: Design of the hybrid effectiveness-implementation IHEART DEPCARE trial.American heart journal · 2025Article
- Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study.BMC psychiatry · 2024Article
- Depression Following Acute Coronary Syndrome: A Review.Reviews in cardiovascular medicine · 2023Review
- Emotional distress and cardiovascular disease risk among participants enrolled in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study.Diabetes research and clinical practice · 2023 · on this mapArticle
- Depression, physical activity, and incident cardiovascular disease among American Indians: The strong heart family study.Psychiatry research communications · 2023Article
- Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial.Addiction science & clinical practice · 2023Article
- Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy.Circulation. Cardiovascular quality and outcomes · 2022Review
- The combined role of obesity and depressive symptoms in the association with ischaemic heart disease and its subtypes.Scientific reports · 2022Article
- Depression Status, Lifestyle, and Metabolic Factors With Subsequent Risk for Major Cardiovascular Events: The China Cardiometabolic Disease and Cancer Cohort (4C) Study.Frontiers in cardiovascular medicine · 2022Article
- Adherence to healthy lifestyle improved clinical outcomes in coronary artery disease patients after coronary intervention.Journal of the Chinese Medical Association : JCMA · 2021Article
- Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID-19 pandemic.Research in nursing & health · 2021Article
- Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease: Results from the COMETA Multicenter Study.Global heart · 2021Article
- Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2020Article
- Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?Open heart · 2020Observational
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesThe aim of this study was to determine whether behavioral mechanisms explain the association between depressive symptoms and myocardial infarction (MI) or death in individuals with coronary heart disease (CHD).
backgroundDepressive symptoms are associated with increased morbidity and mortality in individuals with CHD, but it is unclear how much behavioral mechanisms contribute to this association.
methodsThe study included 4,676 participants with a history of CHD. Elevated depressive symptoms were defined as scores ≥4 on the Center for Epidemiologic Studies Depression 4-item Scale. The primary outcome was definite/probable MI or death from any cause. Incremental proportional hazards models were constructed by adding demographic data, comorbidities, and medications and then 4 behavioral mechanisms (alcohol use, smoking, physical inactivity, and medication non-adherence).
resultsAt baseline, 638 (13.6%) participants had elevated depressive symptoms. Over a median 3.8 years of follow up, 125 of 638 (19.6%) participants with and 657 of 4,038 (16.3%) without elevated depressive symptoms had events. Higher risk of MI or death was observed for elevated depressive symptoms after adjusting for demographic data (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.15 to 1.72) but was no longer significant after adjusting for behavioral mechanisms (HR: 1.14, 95% CI: 0.93 to 1.40). The 4 behavioral mechanisms together significantly attenuated the risk for MI or death conveyed by elevated depressive symptoms (-36.9%, 95% CI: -18.9 to -119.1%), with smoking (-17.6%, 95% CI: -6.5% to -56.0%) and physical inactivity (-21.0%, 95% CI: -9.7% to -61.1%) having the biggest explanatory roles.
conclusionsOur findings suggest potential roles for behavioral interventions targeting smoking and physical inactivity in patients with CHD and comorbid depression.
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