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Predicting adverse events in patients with acute coronary syndrome: an examination of the role of depression and autonomic imbalance


Cardiovascular disease (CVD) - the main cause of acute coronary syndrome (ACS) - and depression are already leading burdens of disease and this" burden is projected to worsen up to 2030. Critically, there is increasing recognition that these disorders are related: depression is independently associated with morbidity and mortality, and is common among patients with CVD. While a variety of biological factors - including the hypothalamic- pituitary-adrenal (HPA) axis and inflammatory processes - contribute to the relationship between depression and CVD, one specific mechanism thought to underlie a substantial part of risk for increased mortality, is autonomic imbalance, indexed by reductions in heart rate variability (HRV). The autonomic nervous system is well suited to play a key regulatory role in inflammatory signaling given its precise and rapid responsivity; in this way acute inflammation is contained and spread of inflammation to the bloodstream prevented. Here we propose to explore the impact of depression on adverse outcomes and its relation to heart rate variability in the prediction of such outcomes as compared to other established risk markers in a longitudinal cohort study of patients with ACS. Strengths of the application include a strong research base in Sao Paulo, Brazil; collaboration with a world leading expert in heart rate variability in Columbus, Ohio, facilitated by a visiting professor from the University of Sydney (Kemp), now based in Sao Paulo and working closely with both Principal Investigators (Bensenor & Thayer). (AU)

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
KEMP, ANDREW H.; KOENIG, JULIAN; THAYER, JULIAN F. From psychological moments to mortality: A multidisciplinary synthesis on heart rate variability spanning the continuum of time. NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS, v. 83, p. 547-567, DEC 2017. Web of Science Citations: 22.
KEMP, ANDREW H.; RODRIGUEZ LOPEZ, SANTIAGO; PASSOS, VALERIA M. A.; BITTENCOURT, MARCIO S.; DANTAS, EDUARDO M.; MILL, JOSE G.; RIBEIRO, ANTONIO L. P.; THAYER, JULIAN F.; BENSENOR, ISABELA M.; LOTUFO, PAULO A. Insulin resistance and carotid intima-media thickness mediate the association between resting-state heart rate variability and executive function: A path modelling study. BIOLOGICAL PSYCHOLOGY, v. 117, p. 216-224, MAY 2016. Web of Science Citations: 13.
KEMP, ANDREW H.; BRUNONI, ANDRE R.; SANTOS, ITAMAR S.; NUNES, MARIA A.; DANTAS, EDUARDO M.; DE FIGUEIREDO, ROBERTA CARVALHO; PEREIRA, ALEXANDRE C.; RIBEIRO, ANTONIO L. P.; MILL, JOSE G.; ANDREAO, RODRIGO V.; THAYER, JULIAN F.; BENSENOR, ISABELA M.; LOTUFO, PAULO A. Effects of Depression, Anxiety, Comorbidity, and Antidepressants on Resting-State Heart Rate and Its Variability: An ELSA-Brasil Cohort Baseline Study. American Journal of Psychiatry, v. 171, n. 12, p. 1328-1334, DEC 2014. Web of Science Citations: 69.

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