title: Depressive symptomatology in relation to 10-year (2004-2014) acute coronary syndrome incidence; the moderating role of diet and financial status.
abstract: BACKGROUND
  The association between depression status and 10-year cardiovascular disease (CVD) incidence among acute coronary syndrome (ACS) patients, in relation to nutritional and financial status, was evaluated.
  
  
  METHODS
  From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 Greek hospitals was enrolled. In 2013-14, the 10-year follow-up was performed. Depressive symptoms were evaluated using the validated CES-D score (range 0-60). Adherence to Mediterranean diet was assessed through MedDietScore (range 0-55) and financial status was determined by the annual income.
  
  
  RESULTS
  Ranking from the 1st to 3rd CES-D tertile, recurrent fatal/non fatal ACS rates were 33%, 37% and 42%, respectively (p=0.006). Multiple logistic regression models revealed an adverse association of severe depression status (i.e. 3rd tertile) compared to no depression (i.e. 1st tertile) [odds ratio (OR)=1.31, 95% confidence interval (95% CI) 1.01, 1.69]. When controlling for financial status, the relationship between depression and ACS prognosis remained marginally significant; while subgroup analysis revealed that only patients with low/moderate income were negatively affected [OR=1.36, 95% CI 0.98, 1.88]. Further stratified analysis, by MedDietScore group, was applied; the above association remained significant only in patients with low compliance to this dietary pattern [OR=1.68, 95% CI 1.10, 2.18].
  
  
  CONCLUSIONS
  ACS coexisting with severe depression status seems to result in adverse disease outcomes while financial status and Mediterranean diet are proposed as potential moderators. Public health programs should focus on vulnerable groups and minimize depressive symptoms through appropriate medical treatment and lifestyle interventions, so as to ameliorate the disease prognosis in clinical and community levels.
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Venetia
authors.initials: V
authors.lastname: Notara
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. Electronic address: d.b.panagiotakos@usa.net.
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Elena
authors.initials: E
authors.lastname: Tsompanaki
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Matina
authors.initials: M
authors.lastname: Kouvari
authors.affiliation: Cardiology Clinic, General Hospital of Karditsa, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Kogias
authors.affiliation: Cardiology Clinic, General Hospital of Lamia, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Papanagnou
authors.affiliation: Cardiology Clinic, General Hospital of Lamia, Greece.
authors.forename: Antonis
authors.initials: A
authors.lastname: Antonoulas
authors.affiliation: Cardiology Clinic, General Hospital of Zakynthos Island, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Stravopodis
authors.affiliation: Cardiology Clinic, General Hospital of Kalamata, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Zombolos
authors.affiliation: Cardiology Clinic, General Hospital of Chalkida, Greece.
authors.forename: Ifigenia
authors.initials: I
authors.lastname: Stergiouli
authors.affiliation: Cardiology Clinic, General Hospital of Chalkida, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Mantas
authors.affiliation: Department of Nursing, Technological Educational Institute of Athens, Greece.
authors.forename: Fotoula
authors.initials: F
authors.lastname: Babatsikou
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000368:Aged; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D004032:Diet / Q000523:psychology* / Q000706:statistics & numerical data; D038441:Diet, Mediterranean / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Cardiovascular disease; Depression; Financial status; Mediterranean diet; Public health; Recurrent cardiac episodes; Secondary prevention