title: Depression and marital status determine the 10-year (2004-2014) prognosis in patients with acute coronary syndrome: the GREECS study.
abstract: BACKGROUND
  The aim of the present work was to examine the association of depression and marital status, with the long-term prognosis of acute coronary syndrome (ACS), among a Greek sample of cardiac patients.
  
  
  METHODS
  From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-2014, the 10-year follow-up was performed in 1918 participants. Depressive symptoms were evaluated using the validated CES-D score (range 0-60), while marital status was classified as: single, married/cohabitants, divorced and widowed at the time of entry to the study.
  
  
  RESULTS
  Patients in the upper tertile of CES-D (>20 score) had 41% (95%CI 14%, 75%) higher risk of ACS incidence as compared with those in the lowest (<7 score). In contrary, married patients had 29% lower risk (95%CI 6%, 46%) of ACS mortality compared with single, widowed or divorced. Multi-adjusted analysis revealed that among the 'not married' patients, 1-point increase in the CES-D score was associated with 2% (p = .02) and 4% (p = .001) higher risk of having non-fatal and fatal cardiac events, respectively.
  
  
  CONCLUSIONS
  The present study highlights the important role of depression in the context of marital relationships among ACS patients. Secondary public health care intervention programmes are needed to improve patient outcomes and minimise disease burden in clinical and community setting.
authors: a Department of Nutrition and Dietetics, School of Health Science and Education , Harokopio University , Athens , Greece.
authors: Venetia
authors: V
authors: Notara
authors: Demosthenes B
authors: DB
authors: Panagiotakos
authors: Evagellos
authors: E
authors: Papataxiarchis
authors: Margarita
authors: M
authors: Verdi
authors: Moscho
authors: M
authors: Michalopoulou
authors: Elena
authors: E
authors: Tsompanaki
authors: Yannis
authors: Y
authors: Kogias
authors: Petros
authors: P
authors: Stravopodis
authors: George
authors: G
authors: Papanagnou
authors: Spyros
authors: S
authors: Zombolos
authors: Ifigenia
authors: I
authors: Stergiouli
authors: Yannis
authors: Y
authors: Mantas
authors: Christos
authors: C
authors: Pitsavos
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000523:psychology*; D000368:Aged; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: cardiovascular disease; depressive symptoms; marital status; public health; risk factors