Comparing the effects of depression,anxiety,and comorbidity on quality-of-life,adverse outcomes,and medical expenditure in Chinese patients with acute coronary syndrome

Background:Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL),adverse outcomes,and medical expenditure in patients with acute coronary syndrome (ACS).However,the relevant data are lacking for Chinese ACS populations,especially regarding different effects of major depression,anxiety,and comorbidity.The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression,anxiety,and comorbidity on QOL,adverse outcomes,and medical expenditure in Chinese patients with ACS.Methods:For this prospective longitudinal study,a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015.Among them,531 patients (82.1%) completed 12-month follow-ups.Logistic regression model was utilized for analyzing the association of baseline major depression,anxiety,and comorbidity with 12-month all-cause mortality,cardiovascular events,QOL,and health expenditure.Results:During a follow-up period of 12 months,7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac rehospitalization.Baseline comorbidity,rather than major depression/anxiety,strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]:1.77,95% confidence interval [CI]:1.22–2.52,P = 0.003).Regarding 12-month non-fatal MI and cardiac re-hospitalization,baseline anxiety (OR:2.83,95% CI:1.33–5.89,P<0.01;OR:4.47,95% CI:1.50–13.00,P<0.01),major depression (OR:2.58,95% CI:1.02–6.15,P<0.05;OR:5.22,95% CI:1.42–17.57,P<0.03),and comorbidity (OR:6.33,95% CI:2.96–13.79,P<0.0001,OR:14.08,95% CI:4.99–41.66,P<0.0001) were all independent predictors,and comorbidity had the highest predictive value.Number of re-hospitalization stay,admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity.Conclusions:Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization.However,comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS.And depression with comorbid anxiety may be a new target of mood status in patients with ACS.

Effect of Long-Term Systolic Blood Pressure Trajectory on Kidney Damage in the Diabetic Population： A Prospective Study in a Community-Based Chinese Cohort

Background：Previous studies have shown that hypertension is an important factor contributing to the occurrence and progression of diabetic kidney damage.However,the relationship between the patterns of blood pressure （BP） trajectory and kidney damage in the diabetic population remains unclear.This prospective study investigated the effect of long-term systolic BP （SBP） trajectory on kidney damage in the diabetic population based on an 8-year follow-up community-based cohort.Methods：This study included 4556 diabetic participants among 101,510 participants.BP,estimated glomerular filtration rate （eGFR）,and urinary protein were measured every 2 years from 2006 to 2014.SBP trajectory was identified by the censored normal modeling.Five discrete SBP trajectories were identified according to SBP range and the changing pattern over time.Kidney damage was evaluated through eGFR and urinary protein value.A multivariate logistic regression model was used to analyze the influence of different SBP trajectory groups on kidney damage.Results：We identified five discrete SBP trajectories：low-stable group （n =864）,moderate-stable group （n =1980）,moderate increasing group （n =609）,elevated decreasing group,（n =679）,and elevated stable group （n =424）.The detection rate of kidney damage in the low-stable group （SBP：118-124 mmHg） was the lowest among the five groups.The detection rate of each kidney damage index was higher in the elevated stable group （SBP：159-172 mmHg） compared with the low-stable group.For details,the gap was 4.14 （11.6% vs.2.8%） in eGFR 〈60 ml.min-1.1.73 m 2 and 3.66 （17.2% vs.4.7%）,3.38 （25.0% vs.7.4%）,and 1.8 （10.6% vs.5.9%） times in positive urinary protein,eGFR 〈60 ml.min-1.1.73 m 2 and/or positive urinary protein,and eGFR decline ≥30%,respectively （P 〈 0.01）.Conclusion：An elevated stable SBP trajectory is an independent risk factor for kidney damage in the diabetic population.