Cardiovascular Journal of Africa: Vol 32 No 2 (MARCH/APRIL 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 2, March/April 2021 76 AFRICA
underlying disease, and adjust for other confounding factors
such as level of income and domestic issues, which we have
shown to be predictors of depression.
The main strength of our study lies in its prospective evaluation
of the effects of LSM on the incidence of depression after coronary
revascularisation and it provides some insight into the varying
responses of the intervention among CABG and PCI participants.
The findings suggest that LSM changes may safely be implemented
without fear of potential adverse cardiovascular events.
Despite its limitations, the study is consistent with previous
studies showing that LSM improves mental functioning and
reduces depression and depression traits.50-53
Clinical implications
Our findings have important clinical applicability, since they
emphasise the relationship between mental and physical
well-being and suggest a successful outcome, particularly in
participants who are able to adhere fully to LSM guidelines
regardless of the mode of revascularisation. Lower levels of
PA short of the required target also appeared to have had
some anti-depressive benefits since a modest benefit accrued in
those who were partly compliant with LSM guidelines. These
findings suggest that ongoing emphasis on counselling patients
to overcome the barriers to engaging in adequate PA, such as
lack of motivation and fear of adverse outcomes, are critical
to a successful outcome, particularly in CABG subjects. This
may well translate into morbidity and mortality benefits in
participants who fully adhere to LSM recommendations.
Conclusion
This study confirms a high prevalence of depressive symptoms in
MI subjects undergoing coronary revascularisation and showed
that participants in the PCI group derived greater benefit from
lifestyle intervention than the CABG group, probably because
of early ambulation. Although depression is amenable to
intervention by LSM measures, the beneficial effect of LSM was
seen mainly among LSM-compliant subjects. Fully compliant
subjects derived equal benefit, regardless of the mode of
revascularisation, emphasising the importance of counselling
to overcome the barriers to full participation in LSM and
undertaking PA. A long-term, randomised study is needed to
verify these findings.
References
1. Carney RM, Freedland KE. Depression and coronary heart disease. Nat
Rev Cardiol 2017; 14(3):145–155.
2. Tully PJ, Newland RF, Baker RA. Cardiovascular risk profile before
coronary artery bypass graft surgery in relation to depression and
anxiety disorders: an age and sex propensity-matched study. Aust Crit
Care 2015; 28(1): 24–30.
3. Donnelly TT, Al Suwaidi JM, Al-Qahtani A, et al. Mood disturbance
and depression in Arab women following hospitalisation from acute
cardiac conditions: a cross-sectional study from Qatar. Br Med J Open
2016; 6(7): e011873.
4. Cohen BE, Edmondson D, Kronish IM. State of the art review: depres-
sion, stress, anxiety, and cardiovascular disease. Am J Hypertens 2015;
28(11): 1295–302.
5. Smolderen KG, Strait KM, Dreyer RP, et al. Depressive symptoms in
younger women and men with acute myocardial infarction: insights
from the VIRGO study. J Am Heart Assoc 2015; 4(4): e001424.
6. Khawaja IS, Westermeyer JJ, Feinstein RE. Depression and coronary
artery disease. Psychiatry (Edgmont) 2009; 6(1): 38–51.
7. Ivanovs R, Kivite A, Ziedonis D, et al. Association of depression and
anxiety with cardiovascular co-morbidity in a primary care population
in Latvia: A cross-sectional study. BMC Public Health 2018; 18(1): 328.
8. Van Dijk MR, Utens EM, Dulfer K, et al. Depression and anxiety
symptoms as predictors of mortality in PCI patients at 10 years of
follow-up. Eur J Prev Cardiol 2016; 23(5): 552–558.
9. Freedland KE, Carney RM. Depression as a risk factor for adverse
outcomes in coronary heart disease. BMC Med 2013; 11: 131.
10. Stenman M, Holzmann MJ, Sartipy U. Relation of major depression
to survival after coronary artery bypass grafting. Am J Cardiol 2014;
114(5): 698–703.
11. Carney R, Freedland K. Depression and coronary heart disease. Nat
Rev Cardiol 2017; 14: 145–155.
12. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a
risk factor for poor prognosis among patients with acute coronary
syndrome: systematic review and recommendations: a scientific state-
ment from the American Heart Association. Circulation 2014; 129(12):
1350–1369.
13. Carl JL, Randal JT, Richard VM, et al. Exercise training and cardiac
rehabilitation in primary and secondary prevention of coronary heart
disease. Mayo Clin Proc 2009; 84(4): 373–383.
14. Pelletier R, Lavoie KL, Bacon SL, et al. Depression and disease severity
in patients with premature acute coronary syndrome. Am J Med 2014;
127(1): 87–93.e2.
15. Meijer A, Conradi HJ, Bos EH, et al. Prognostic association of depres-
sion following myocardial infarction with mortality and cardiovascular
events: A metaanalysis of 25 years of research. Gen Hosp Psych 2011;
33(3): 203–216.
16. May HT, Horne BD, Knight S, et al. The association of depression at
any time to the risk of death following coronary artery disease diagnosis.
Eur Heart J Qual Care Clin Outcomes 2017; 3(4): 296–302.
17. Carney RM, Freedland KE. Depression in patients with coronary artery
disease: a more significant problem than previously recognized? Eur
Heart J- Qual Care Clin Outcomes 2017; 4(3): 262–263.
18. Rutledge T, Redwine LS, Linke SE, et al. A meta-analysis of mental
health treatments and cardiac rehabilitation for improving clinical
outcomes and depression among patients with coronary heart disease.
Psychosoc Med 2013; 75(4): 335–349.
19. Pratt LA, Ford DE, Crum RM, et al. Depression, psychotropic medi-
cation, and risk of myocardial infarction. Prospective data from the
Baltimore ECA follow-up. Circulation 1996; 94(12): 3123–3129.
20. Mensah GA, Wei GS, Sorlie PD, et al. Decline in cardiovascular mortal-
ity: possible causes and implications. Circ Res 2017; 120(2): 366–380.
21. Wang H, Naghavi M, Allen C, et al. Global, regional, and national life
expectancy, all-cause mortality, and cause-specific mortality for 249
causes of death, 1980–2015: a systematic analysis for the Global Burden
of Disease Study 2015. Lancet 2016; 388(10053): 1459–1544.
22. Global Health Estimates 2016: Disease burden by Cause, Age, Sex,
by Country and by Region, 2000–2016. Geneva, World Health
Organization, 2018. Available online:
global_burden_disease/estimates/en/index1.html.
23. Roth GA, Johnson C, Abajobir A, at al. Global, regional, and national
burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll
Cardiol 2017; 70(1): 1–25.
24. Pourafkari L, Ghaffari S, Tajlil A, et al. The impact of cardiac rehabili-