Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Relationship between Depression, Stress-Related Neurobiology, and Incident Heart Failure: Understanding the Neurobiological Mechanisms Underlying Exercise as a Preventive Measure(Saudi Digital Library, 2023-04) Alhamam, Abdulaziz Arif Abdulaziz; Tawakol, AhmedBackground: Depression is associated with risk of developing heart failure (HF). Also, higher stress-related neural activity (SNA) associates with subsequent risk of cardiovascular disease. We investigated whether depression predicts subsequent HF through heightened SNA. Methods: Individuals (N=102,028; median age 57 years; 42.6% male) enrolled in the Mass General Brigham Biobank were identified to study the association of depression and incident HF, subset of 1,227 who underwent clinically indicated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging were retrospectively identified. SNA was measured using validated methods, as amygdalar metabolic activity corrected for regulatory brain (i.e., medial prefrontal cortical) activity. Depression and subsequent development of HF was determined via medical record review using International Classification of Diseases 10 (ICD-10) codes. Survival analyses using Cox and Kaplan-Meier models were performed. Results: Over a median follow-up period of 3.5 (IQR 2.0-5.0) years, 2,631 (2.6%) individuals developed HF (717 Heart failure with reduced ejection fraction (HFrEF), 1,214 Heart failure with preserved ejection fraction (HFpEF)). Individuals with subsequent HF (versus no HF) had higher baseline SNA (mean Z-score 0.19 ± 1.07 versus -0.08 ± 0.99; p=0.005, adjusted for age and sex). SNA associated with subsequent HF when divided into tertiles (Figure 2B) and as a continuous measure (standardized HR [95% CI]: 1.40 [1.13-1.74], p=0.002, adjusted for age, sex, hypertension, hyperlipidemia, diabetes, and smoking). The association between depression and HF subtype was stronger for HFpEF (1.46 [1.28-1.65], p<0.001) than for HFrEF (1.09 [0.92 -1.3], p=0.32). Conclusion: In this retrospective study of individuals with depression have higher risk of incident HF through heightened SNA with a somewhat stronger association for HFpEF. Understanding the link between depression and subsequent HF may provide important insights into better HF prevention and management strategies.16 0