Depression Clinical Trial
To understand how depression leads to congestive heart failure (CHF) in older adults.
BACKGROUND:
Depression is known to be associated with an increased risk of coronary heart disease (CHD),
and with adverse outcomes among older adults with CHD. Recent evidence suggests that
depression is also associated with an increased risk of congestive heart failure, and with
adverse outcomes among older adults with congestive heart failure. However, the mechanisms
by which depression leads to congestive heart failure are not known
DESIGN NARRATIVE:
To determine the mechanisms of association between depression and CHF, the investigators
will use an existing cohort of 1024 older adults (mean age 67) with CHD (including 680 with
no heart failure and 344 with clinical or subclinical heart failure) who were recruited
between September 2000 and December 2002 for "The Heart and Soul Study." The Heart and Soul
Study was originally designed to understand the mechanism of association between depression
and CHD. Since patients with CHD are at high risk for CHF, this well-characterized cohort
will provide a unique opportunity to examine the relation between depression and CHF. At
baseline, participants completed a depression interview (Diagnostic Interview Schedule);
full exercise treadmill testing with stress echocardiography; 24-hour Holter monitoring for
heart rate variability; 24-hour urine collection for cortisol and norepinephrine; venous
blood measurements for lipids, platelet reactivity, and C-reactive protein; and an extensive
questionnaire. Participants have been followed annually by telephone. The investigators will
invite all participants to return for a 5-year examination, and will follow them for an
additional 3 years thereafter, to determine (a) the independent association between baseline
depression and CHF, and (b) the extent to which 5-vear changes in biological and behavioral
factors associated with depression explain the relation between depression and CHF. By
identifying the mechanisms that explain the relation between depression and CHF, this study
will enable them to target specific areas for improving the treatment of these patients.
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