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Resumo Fundamento: Sintomas depressivos estão associados de forma independente ao risco aumentado de doença cardiovascular (DCV) em indivíduos com DCV não diagnosticada. Os mecanismos subjacentes a essa associação, entretanto, não estão claros. Inflamação tem sido indicada como um possível elo mecanicista entre depressão e DCV. Objetivos: Este estudo avaliou a associação entre sintomas depressivos persistentes e o início de inflamação de baixo grau. Métodos: De um banco de dados de 1.508 indivíduos jovens (idade média: 41 anos) sem diagnóstico de DCV submetidos a pelo menos duas avaliações de saúde de rotina, 134 tinham sintomas depressivos persistentes (Inventário de Depressão de Beck - BDI ≥10, BDI+) e 1.374 não apresentavam sintomas em nenhuma das ocasiões (BDI-). Todos os participantes foram submetidos a repetidas avaliações clínicas e laboratoriais em seguimento regular, cuja média foi de 26 meses desde a condição basal. Definiu-se inflamação de baixo grau como concentração plasmática de proteína C reativa (PCR) ultrassensível > 3 mg/L. O desfecho foi a incidência de inflamação de baixo grau por ocasião da segunda avaliação clínica. Resultados: A incidência de inflamação de baixo grau foi maior no grupo BDI+ em comparação ao grupo BDI- (20,9% vs. 11,4%; p = 0,001). Após ajuste para sexo, idade, circunferência abdominal, índice de massa corporal, níveis de atividade física, tabagismo e prevalência de síndrome metabólica, os sintomas depressivos persistentes continuaram sendo um preditor independente de início de inflamação de baixo grau (OR = 1,76; IC 95%: 1,03-3,02; p = 0,04). Conclusões: Sintomas depressivos persistentes foram independentemente associados com início de inflamação de baixo grau em indivíduos saudáveis.

Abstract Background: Depressive symptoms are independently associated with an increased risk of cardiovascular disease (CVD) among individuals with non-diagnosed CVD. The mechanisms underlying this association, however, remain unclear. Inflammation has been indicated as a possible mechanistic link between depression and CVD. Objectives: This study evaluated the association between persistent depressive symptoms and the onset of low-grade inflammation. Methods: From a database of 1,508 young (mean age: 41 years) individuals with no CVD diagnosis who underwent at least two routine health evaluations, 134 had persistent depressive symptoms (Beck Depression Inventory - BDI ≥ 10, BDI+) and 1,374 had negative symptoms at both time points (BDI-). All participants had been submitted to repeated clinical and laboratory evaluations at a regular follow-up with an average of 26 months from baseline. Low-grade inflammation was defined as plasma high-sensitivity C-Reactive Protein (CRP) concentrations > 3 mg/L. The outcome was the incidence of low-grade inflammation evaluated by the time of the second clinical evaluation. Results: The incidence of low-grade inflammation was more frequently observed in the BDI+ group compared to the BDI- group (20.9% vs. 11.4%; p = 0.001). After adjusting for sex, age, waist circumference, body mass index, levels of physical activity, smoking, and prevalence of metabolic syndrome, persistent depressive symptoms remained an independent predictor of low-grade inflammation onset (OR = 1.76; 95% CI: 1.03-3.02; p = 0.04). Conclusions: Persistent depressive symptoms were independently associated with low-grade inflammation onset among healthy individuals.

https://doi.org/10.5935/abc.20170080 1586 downloads

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population
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Squarzoni, Paula

; Tamashiro-Duran, Jaqueline H.

; Duran, Fabio L.S.

; Leite, Claudia C.

; Wajngarten, Mauricio

; Scazufca, Marcia

; Menezes, Paulo R.

; Lotufo, Paulo A.

; Alves, Tania C.T.F.

; Busatto, Geraldo F.

Clinics

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Ago 2017, Volume 72 Nº 8 Páginas 474 - 480

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.

https://doi.org/10.6061/clinics/2017(08)04 719 downloads

Acute management of unstable angina and non-ST segment elevation myocardial infarction
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Silva, Fernando Morita Fernandes

; Pesaro, Antonio Eduardo Pereira

; Franken, Marcelo

; Wajngarten, Mauricio

einstein (São Paulo)

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Set 2015, Volume 13 Nº 3 Páginas 454 - 461

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A síndrome coronária sem supradesnivelamento do ST geralmente resulta da instabilização de uma placa aterosclerótica, com subsequente ativação plaquetária e de diversos fatores de coagulação. O tratamento visa aliviar a dor isquêmica, limitar o dano miocárdico e diminuir a mortalidade. Diversos agentes antiagregantes e anticoagulantes provaram sua utilidade, e novas drogas passaram a compor o arsenal terapêutico, buscando maior eficácia anti-isquêmica e menores índices de sangramento. Apesar dos avanços, as taxas de mortalidade, infarto e reinternação ainda permanecem elevadas.

Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.

https://doi.org/10.1590/S1679-45082015RW3172 42366 downloads

Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease
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Rodrigues, Giselle Helena de Paula

; Gebara, Otavio Celso Eluf

; Gerbi, Catia Cilene da Silva

; Pierri, Humberto

; Wajngarten, Mauricio

Arquivos Brasileiros de Cardiologia

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Jun 2015, Volume 104 Nº 6 Páginas 443 - 449

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Fundamento:Com o envelhecimento, a prevalência de doenças crônico-degenerativas sofreu aumento progressivo. A repercussão dessas doenças sobre a capacidade funcional foi reconhecida. Outro parâmetro de saúde é a “qualidade de vida relacionada à saúde”. Na população idosa, as doenças cardiovasculares destacam-se pelo impacto epidemiológico e clínico. Elas, geralmente, vêm associadas a outras afecções. Esse conjunto de problemas pode comprometer a independência e a qualidade de vida do idoso que busca tratamento cardiológico.Objetivo:Avaliar, em uma população de idosos cardiopatas, quais são os determinantes clínicos mais relevantes de dependência e de qualidade de vida.Métodos:O grupo foi selecionado aleatória e consecutivamente, sendo aplicados quatro questionários: HAQ, SF-36, PRIME‑MD e Mini Exame do Estado Mental.Resultados:Incluiu-se 1020 idosos, 63,3% mulheres. O grupo tinha em média 75,56 ± 6,62 anos. 61,4% mostrou-se independente ou com dependência leve. O escore de qualidade de vida foi elevado (HAQ: 88,66 ± 2,68). 87,8% dos pacientes apresentou escore total do SF-36 ≥ 66. À análise multivariada, a associação entre os diagnósticos e graus elevados de dependência foi significante apenas para acidente vascular cerebral prévio (p = 0,014), obesidade (p < 0,001), sedentarismo (p = 0,016), osteoartrite (p < 0,001), déficit cognitivo (p < 0,001), e depressão maior (p < 0,001). Ao analisarmos a qualidade de vida, a depressão maior e a depressão por doença física associou-se significativamente com todos os domínios do SF-36.Conclusão:Em uma população de idosos cardiopatas, os determinantes clínicos mais relevantes de prejuízos para dependência e qualidade de vida foram as comorbidades não cardiovasculares, particularmente a depressão.

Background:The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists.Objective:Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life.Methods:This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State.Results:The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36.Conclusion:Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.

https://doi.org/10.5935/abc.20150034 4408 downloads

Behavioral Cardiology: Cardiology’s New Frontier of Action
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Katz, Marcelo

; Wajngarten, Mauricio

Arquivos Brasileiros de Cardiologia

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Jan 2015, Volume 104 Nº 1 Páginas 3 - 4

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20150002 1904 downloads

Predictors of the risk of falls among elderly with chronic atrial fibrillation
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Santos, Angela Cristina Silva dos

; Nobre, Moacyr Roberto Cucê

; Nussbacher, Amit

; Rodrigues, Giselle Helena de Paula

; Gebara, Otavio Celso Eluf

; Serro Azul, João Batista Carvalho

; Wajngarten, Mauricio

Clinics

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2012, Volume 67 Nº 4 Páginas 305 - 311

Resumo: En | Texto: En | PDF: En

OBJECTIVES: Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed. METHODS: From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 107 took part in this study. Their age was 77.9±6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied. RESULTS: At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that selfreported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%. CONCLUSION: In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests.

https://doi.org/10.6061/clinics/2012(04)02 2862 downloads

Simultaneous transfer of cholesterol, triglycerides, and phospholipids to high-density lipoprotein in aging subjects with or without coronary artery disease
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Azevedo, Carolina H. M

; Wajngarten, Maurício

; Prete, Ana C. Lo

; Diament, Jayme

; Maranhão, Raul C

Clinics

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2011, Volume 66 Nº 9 Páginas 1543 - 1548

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To verify whether the capacity of high-density lipoprotein (HDL) to simultaneously receive nonesterified cholesterol, triglycerides, cholesteryl esters, and phospholipids changes with aging and the presence of coronary artery disease. DESIGN: Cross-sectional study with biochemical analyses. SUBJECTS: Eleven elderly patients with coronary artery disease (74±5 years) were compared with the following groups of non-coronary artery disease subjects (referred to as "healthy"): 25 young (25±5 years), 25 middle-aged (42± years), and 25 elderly subjects (75±8 years). METHODS: Plasma samples were incubated with a nanoemulsion labeled with radioactive lipids; the transfer of the lipids from the nanoemulsion to the HDL was measured in chemically precipitated HDL. HDL size and paraoxonase-1 activity were also determined. RESULTS: The transfer of cholesteryl esters and phospholipids to high-density lipoprotein was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. Non-esterified cholesterol and triglyceride transfer was not different among these three groups. The HDL size was significantly greater (p<0.001) in healthy elderly subjects than in the middle-aged and younger subjects. The paraoxonase-1 activity was similar among the groups. Compared with healthy elderly subjects, coronary artery disease elderly subjects had significantly less (p<0.05) transfer of non-esterified cholesterol, triglycerides, and cholesteryl esters to the HDL and a significantly smaller (p<0.05) HDL size. CONCLUSION: Because lipid transfer is enhanced in healthy elderly subjects but not in those with coronary artery disease, increasing lipid transfer to HDL may be a protective mechanism against the disease.

1798 downloads

10.

Hipertensão e condições clínicas associadas
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Ferreira Filho, Sebastião

; Paula, Rogério Baumgratz de

; Avezum, Álvaro

; Freitas, Gabriel R. de

; Francischetti, Emílio

; Batista, Marcelo

; Carvalho, Maria Helena Catelli

; Zanella, Maria Tereza

; Gomes, Marília de Brito

; Wajngarten, Maurício

; Melo, Nilson Roberto de

; Coelho, Otávio Rizzi

; Meirelles, Ricardo M. da Rocha

; Miranda, Roberto

; Milagres, Rosangela

Brazilian Journal of Nephrology

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Set 2010, Volume 32 Supl. 1 Páginas 60 - 64

Resumo: Pt | Texto: Pt | PDF: Pt

6276 downloads

11.

Intervenção coronária percutânea em idosos
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Gebara, Otavio C. E.

; Wajngarten, Mauricio

Revista Brasileira de Cardiologia Invasiva

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2010, Volume 18 Nº 1 Páginas 13 - 14

Resumo: Pt | Texto: Pt | PDF: Pt

696 downloads

12.

II Diretrizes em cardiogeriatria da Sociedade Brasileira de Cardiologia
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Gravina, Cláudia F.

; Franken, Roberto

; Wenger, Nanette

; Freitas, Elizabete Viana de

; Batlouni, Michel

; Rich, Michel

; Liberman, Alberto

; Nussbacher, Amit

; Forman, Daniel

; Martinelli, Martino

; Santos, Silvio Carlos

; Feitosa, Gilson Soares

; Meneghello, Zilda Machado

; Rosa, Ronaldo F.

; Wajngarten, Maurício

; Wei, Jeanne

Arquivos Brasileiros de Cardiologia

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2010, Volume 95 Nº 3 Páginas e16 - e76

Resumo: Pt | Texto: Pt | PDF: Pt

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13.

The role of invasive therapies in elderly patients with acute myocardial infarction
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Nicolau, José C.

; Lemos, Pedro A.

; Wajngarten, Maurício

; Giraldez, Roberto R.

; Serrano Jr., Carlos V.

; Martinez, Eulógio E.

; Baracioli, Luciano M.

; Kalil, Roberto

; Jatene, Fábio B.

; Dallan, Luis A.

; Puig, Luis B.

; Stolf, Noedir A.

Clinics

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Jun 2009, Volume 64 Nº 6 Páginas 553 - 560

Resumo: En | Texto: En | PDF: En

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.

1536 downloads

14.

The prevalence of thyroid dysfunction in elderly cardiology patients with mild excessive iodine intake in the urban area of São Paulo
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Duarte, Glaucia C.

; Tomimori, Eduardo K.

; Camargo, Rosalinda Y. A.

; Rubio, Ileana G.S.

; Wajngarten, Mauricio

; Rodrigues, Amanda G.

; Knobel, Meyer

; Medeiros-Neto, Geraldo

Clinics

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Fev 2009, Volume 64 Nº 2 Páginas 135 - 142

Resumo: En | Texto: En | PDF: En

OBJECTIVES: To evaluate the prevalence of thyroid dysfunction in elderly cardiac patients in an outpatient setting. SUBJECTS AND METHODS: A total of 399 consecutive patients (268 women, age range 60-92 years) who were followed at Heart Institute were evaluated for thyroid dysfunction with serum free T4, TSH, anti-Peroxidase antibodies, urinary iodine excretion measurements and thyroid ultrasound. RESULTS: Hyperthyroidism (overt and subclinical) was present in 29 patients (6.5%), whereas hypothyroidism (overt and subclinical) was found in 32 individuals (8.1%). Cysts were detected in 11 patients (2.8%), single nodules were detected in 102 (25.6%), and multinodular goiters were detected in 34 (8.5%). Hashimoto's thyroiditis was present in 16.8% patients, most of whom were women (83.6%). The serum TSH increased with age and was significantly higher (p= <0.01) in patients, compared to the normal control group. No significant differences in serum TSH and free T4 values were observed when patients with atrial fibrillation (AF) where compared with those without arrhythmia. The median urinary iodine levels were 210 µg/L (40-856 µg/L), and iodine levels were higher in men than in women (p<0.01). Excessive iodine intake (urinary iodine >300 µg/L) was observed in one-third of patients (30.8%). CONCLUSIONS: Elderly patients have a higher prevalence of both hypo- and hyperthyroidism as well as thyroid nodules when compared with the general population. About one-third of the older patients had elevated urinary secretion of iodine and a higher prevalence of chronic Hashimoto's thyroiditis. It is recommended that ultrasonographic studies, tests for thyroid function and autoimmunity should be evaluated in elderly patients.

3324 downloads

15.

Depressão e infarto agudo do miocárdio
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Alves, Tânia Correa de Toledo Ferraz

; Fráguas, Renério

; Wajngarten, Mauricio

Archives of Clinical Psychiatry (São Paulo)

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2009, Volume 36 Supl. 3 Páginas 88 - 92

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A associação entre transtorno depressivo maior e doenças cardiovasculares, em particular infarto agudo do miocárdio, é frequente, levando a pior prognóstico tanto da depressão como da doença cardiovascular, com maiores taxas de reinfarto e maior morbidade e mortalidade. Os autores discutem as evidências na literatura que demonstram essa associação entre infarto agudo do miocárdio e quadros depressivos, com enfoque nos avanços em fisiopatologia e terapêutica psiquiátrica. Vários estudos têm mostrado que o tratamento da depressão associada a quadros cardíacos é eficaz, melhora a qualidade de vida e pode ser feito com segurança. Embora o tratamento da depressão tenha sido associado à melhora de alguns parâmetros cardiovasculares, ainda não existem, entretanto, evidências de associação entre tratamento da depressão e melhora da morbidade e mortalidade cardiovascular.

The association between major depressive disorder and cardiovascular diseases, particularly myocardial infarction, is frequently observed, leading to worse prognosis both on the depressive disorder as well as cardiovascular disease, with increased rates of re-infarction and both morbidity and mortality. The authors review and discuss the evidence in the literature that supports the relationship between depressive disorder and cardiovascular disease, with focus on the advances on the physiopathology and the psychiatric management. Various studies have shown that treatment of depression is efficacious, improves quality of life and can be safely conducted. Although, treatment of depression has been associated with improvement on some cardiovascular parameters, there is no evidence so far that treatment of depression is associated with decrease of cardiovascular morbidity and mortality.

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