Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study

Fàrmac antidepressiu; Càncer; Síndrome depressiuFármaco antidepresivo; Cáncer; Síndrome depresivoAntidepressant drug; Cancer; Depressive syndromeObjective: This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort.Methods: A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality.Results: The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11–4.44) and women (HR = 3.69; 95% CI = 1.69–8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46–3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10–6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76–4.90) only in the male population.Conclusion: C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.Objectiu: aquest estudi pretenia avaluar l'associació de símptomes depressius somàtics (SDS), símptomes depressius cognitius/emocionals (C-EDS) i tractament antidepressiu sobre la mortalitat per càncer i altres causes en una cohort comunitària. Mètodes: una mostra basada en la comunitat reclutada el 1995, 2000 i 2005 d'entre 35 i 75 anys es va examinar en dues onades i es va seguir durant una mitjana de 6,7 anys. Els fenotips SDS i C-EDS es van avaluar mitjançant el Patient Health Questionnaire-9. Es van recollir els medicaments utilitzats pels participants. Durant el seguiment es van registrar les morts i les seves causes. Es van realitzar models de risc proporcional de Cox estratificats per sexe per determinar l'associació entre fenotips depressius i mortalitat. Resultats: La cohort estava formada per 5.646 individus (53,9% dones) amb una edat mitjana de 64 anys (DE = 11,89). Durant el seguiment es van registrar 392 defuncions, de les quals el 27,8% van ser per càncer. El fenotip C-EDS es va associar amb un augment del risc de mortalitat per càncer tant en homes (HR = 2,23; IC 95% = 1,11-4,44) com en dones (HR = 3,69; IC 95% = 1,69-8,09), i el SDS es va associar significativament. amb mortalitat no per càncer en homes (HR = 2,16; IC 95 % = 1,46–3,18). Els inhibidors selectius de la recaptació de serotonina (ISRS) es van associar significativament tant amb el càncer (HR = 2,78; IC 95% = 1,10-6,98) com amb la mortalitat no per càncer (HR = 2,94; IC 95% = 1,76-4,90) només a la població masculina. Conclusió: el fenotip C-EDS es va relacionar amb un augment del risc de mortalitat per càncer als 6 anys. A més, l'ús d'ISRS a la població masculina es va associar amb càncer i mortalitat per totes les causes.This study was supported by the research grant STL006/17/00234 from the Strategic Plan for Health Research and Innovation (PERIS) 2016–2020 of the Department of Health, Government of Catalonia. The funding sources played no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript

Gender analysis of the frequency and course of depressive disorders and relationship with personality traits in general population: a prospective cohort study

Depressió; Epidemiologia; PersonalitatDepresión; Epidemiología; PersonalidadDepression; Epidemiology; PersonalityBackground: We aimed to determine the prevalence and course of subthreshold depressive symptomatology (sDS) and probable major depressive episode (MDE) and to examine their association with personality traits among men and women. Methods: A community-based sample aged 35 years or older was examined in two waves (median follow-up of 6.9 years). The Patient Health Questionnaire-9 (PHQ-9) was used to assess sDS and MDE. The 10-item version of the Big Five Inventory was used to assess personality traits. Prevalence was assessed at baseline (n=5,557) and incidence and persistence-recurrence rates were computed at follow up (n=3,102). Logistic regression models were adjusted to explore the association of personality traits with prevalence and course of depressive disorders. Results: The prevalence of sDS and MDE was 14.04% (95% CI = 17.04-19.08) and 8.54 (95% CI=7.82-9.31), the incidence was 14.30 per 1,000 person-years (95% CI=12.49-16.31) and 4.34 per 1,000 person-years (95% CI=3.46-5.36), and the persistence-recurrence was 35.04 per 1,000 person-years (95% CI=29.00-41.96) and 28.8 per 1,000 person-years (95% CI=20.49-38.14). The gender gap was higher for MDE. Personality traits were differentially associated with the prevalence and course of depressive disorders between men and women. Limitations: Because this study used questionnaires to assess depressive disorders and personality traits, information bias could not be ruled out. Conclusions: The gender gap was higher for the prevalence and course of the probable MDE. There were more personality traits related with the course of the sDS and they had a major role in the course of the probable MDE in women.This study was supported by research grant STL006/17/00234 from the Strategic Plan for Health Research and Innovation (PERIS) 2016-2020 of the Department of Health. Government of Catalunya

Polyvascular Subclinical Atherosclerosis: Correlation Between Ankle Brachial Index and Carotid Atherosclerosis in a Population-Based Sample

We assessed the correlation between the biomarkers of lower limb atherosclerosis (eg, ankle-brachial index [ABI]) and of carotid atherosclerosis (eg, common carotid intima-media thickness (IMT) and presence of atherosclerotic plaque) in a population-based cohort from Girona (Northwest Spain) recruited in 2010. Ankle-brachial index and carotid ultrasound were performed in all participants. Generalized additive multivariable models were used to adjust a regression model of common carotid IMT on ABI. Logistic regression multivariable models were adjusted to assess the probability of carotid plaque in individuals with peripheral artery disease. We included 3307 individuals (54.2% women), mean age 60 years (standard deviation 11). Two patterns of association were observed between subclinical biomarkers of atherosclerosis at the lower limb and carotid artery. Ankle-brachial index and common carotid IMT showed a linear trend in men [beta coefficient (95% confidence interval) =-.068 (-.123; -.012); P = .016]. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery [Odds ratio (95% confidence interval) = 2.61, (1.46; 4.69); P = .001]. Men showed a significant linear association between ABI levels and common carotid IMT values. Women with peripheral artery disease presented with high risk of atherosclerotic plaque at the carotid artery

Do individuals with autoimmune disease have increased risk of subclinical carotid atherosclerosis and stiffness?

To explore the role of chronic inflammation inherent to autoimmune diseases in the development of subclinical atherosclerosis and arterial stiffness, this study recruited two population-based samples of individuals with and without autoimmune disease (ratio 1:5) matched by age, sex, and education level and with a longstanding (≥6 years) diagnosis of autoimmune disease. Common carotid intima media thickness (IMT) and arterial distensibility and compliance were assessed with carotid ultrasound. Multivariable linear and logistic regression models were adjusted for 10-year cardiovascular risk. In total, 546 individuals with and without autoimmune diseases (91 and 455, respectively) were included. Mean age was 66 years (standard deviation 12), and 240 (43.9%) were women. Arterial stiffness did not differ according to presence of autoimmune diseases. In men, the diagnosis of autoimmune diseases significantly increased common carotid IMT [beta-coefficient (95% confidence interval): 0.058 (0.009; 0.108); p-value=0.022] and the percentage having IMT ≥ percentile 75 [1.012 (0.145; 1.880); p-value=0.022]. Women without autoimmune disease were more likely to have IMT ≥ percentile 75 [-2.181 (-4.214; -0.149); p-value=0.035] but analysis of IMT as a continuous variable did not yield significant results. In conclusion, subclinical carotid atherosclerosis, but not arterial stiffness, was higher in men with autoimmune diseases. Women did not show significant differences in any of these carotid features. Sex was an effect modifier in the association between common carotid IMT values and the diagnosis of autoimmune diseases

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Health behaviour; Health promotion; Hybrid trialComportamiento de salud; Promoción de la salud; Prueba híbridaComportament de salut; promoció de la salut; Prova híbridaBackground This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis

IntroductionThe healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals’ approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up.MethodsThis protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC.DiscussionThe analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020

Statins and new-onset atrial fibrillation in a cohort of patients with hypertension: analysis of electronic health records, 2006-2015

Atrial Fibrillation; Electronic Health Records; HypertensionFibrilación atrial; Registros Electrónicos de Salud; HipertensiónFibril·lació atrial ; Registres Electrònics de Salut; HipertensióHypertension is the most prevalent risk factor for new-onset atrial fibrillation (AF). But few studies have addressed the effect of statins on the incidence of this arrhythmia in patients with hypertension. This study aimed to evaluate the effect of statins on new-onset of this arrhythmia in a hypertensive population, accounting for AF risk. Data from the Information System for the Development of Research in Primary Care was used to recruit a retrospective cohort of ≥55-year-old hypertensive individuals with no ischemic vascular disease, in 2006-2007, followed up through 2015. The effect of initiating statin treatment on new-onset atrial fibrillation was assessed with Cox proportional hazards models adjusted by the propensity score of receiving statin treatment, in the overall study population and stratified by AF risk. Of 100 276 included participants, 9814 initiated statin treatment. The AF incidence per 1000 person-years (95% confidence interval) was 12.5 (12.3-12.8). Statin use associated with a significant (9%) reduction in AF incidence. Differences in absolute AF incidence were higher in the highest AF risk subgroup, and the estimated number needed to treat to avoid one case was 720. The relative effect was poor, similar across groups, and non-significant, as was the association of statins with adverse effects. We found a limited protective effect of statins over new-onset AF in this hypertensive population with no ischemic vascular disease. If there is no further indication, hypertensive patients would not benefit from statin use solely for AF primary prevention

Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45–75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions’ effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45–75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = −0.09 (95% CI: −0.29–0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: −0.32–0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01–0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64–1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55–1.73), no smoking OR = 0.61 (95% CI: 0.54–1.06), EVA adjusted mean difference = −1.26 (95% CI: −4.98–2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis

IntroductionThe healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals’ approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up.MethodsThis protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC.DiscussionThe analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020

Glycemic markers and relation with arterial stiffness in Caucasian subjects of the MARK study

[EN]BACKGROUND: Effect of prediabetes and normal glucose on arterial stiffness remains controversial. The primary aim of this study was to investigate the relationship of fasting plasma glucose (FPG), postprandial glucose (PG) and glycosylated haemoglobin (HbA1c) with brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) in Caucasian adults. The secondary aim was to analyse this relationship by glycaemic status. METHODS: Cross-sectional study. Setting: Primary care. Participants: 2,233 subjects, 35-74 years. Measures: FPG (mg/dL) and HbA1c (%) of all subjects were measured using standard automated enzymatic methods. PG (mg/dL) was self-measured at home two hours after meals (breakfast, lunch and dinner) for one day using an Accu-chek ® glucometer. CAVI was measured using a VaSera VS-1500® device (Fukuda Denshi), and baPWV was calculated using a validated equation. RESULTS: CAVI and baPWV values were significantly higher in subjects with diabetes mellitus than in glucose normal and prediabetes groups (p<0.001). FPG, PG and HbA1c were positively associated with CAVI and baPWV. The β regression coefficient for: HbA1c was 0.112 (CI 95% 0.068 to 0.155) with CAVI, 0.266 (CI 95% 0.172 to 0.359) with baPWV; for PG was 0.006 (CI 95% 0.004 to 0.009 and for FPG was 0.005 (CI 95% 0.002 to 0.008) with baPWV; and for PG was 0.002 (CI 95% 0.001 to 0.003) and 0.003 (CI 95% 0.002 to 0.004) with CAVI (p<0.01 in all cases). When analysing by hyperglycaemic status, FPG, PG and HbA1c were positively associated with CAVI and baPWV in subjects with type 2 diabetes mellitus. CONCLUSION: FPG, PG and HbA1c show a positive association with CAVI and baPWV, in Caucasian adults with intermediate cardiovascular risk factors. When analysing by hyperglycaemic status, the association is only maintained in subjects with type 2 diabetes mellitus