title: The Relationship of Depressive Symptoms and Vitamin D Intake to Cardiac Event-Free Survival in Patients With Heart Failure.
abstract: BACKGROUND
  Low vitamin D and depressive symptoms are associated with inflammation activation that predicts cardiovascular disease. Little is known about the relationships among vitamin D intake, depressive symptoms, and cardiac events in heart failure (HF).
  
  
  OBJECTIVE
  The aim of this study is to determine the relationships among vitamin D deficiency, depressive symptoms, and cardiac events.
  
  
  METHODS
  A total of 204 HF patients completed a 3-day food diary to determine average daily intake of vitamin D. Patients completed the Patient Health Questionnaire-9 to assess somatic and cognitive depressive symptoms and were split into 2 groups using the Patient Health Questionnaire-9 cut-point score of 10 (< 10, no depressive symptoms; ≥ 10, depressive symptoms). Data on cardiac events during 1 year were obtained through medical record review. Hierarchical Cox and logistic regressions were used for data analyses.
  
  
  RESULTS
  Sixty patients (29.4%) had depressive symptoms and 106 (52.0%) had vitamin D deficiency. Depressive symptoms (hazard ratio [HR], 1.93; P = .031) and vitamin D deficiency (HR, 1.84, P = .036) predicted shorter cardiac event-free survival in Cox regression. Depressive symptoms predicted shorter cardiac event-free survival in patients with vitamin D deficiency (HR, 2.16; P = .038), but not those with vitamin D adequacy. Somatic depressive symptoms were associated with vitamin D deficiency (odds ratio, 1.12; P = .028) in logistic regression, whereas cognitive depressive symptoms were not.
  
  
  CONCLUSIONS
  Vitamin D deficiency and depressive symptoms predicted shorter cardiac event-free survival. Depressive symptoms did not predict cardiac events in HF patients with vitamin D adequacy. Somatic depressive symptoms predicted vitamin D deficiency, but cognitive depressive symptoms did not. Additional research is necessary to determine the protective role of vitamin D in the link between somatic depressive symptoms and cardiac events.
authors.affiliation: Eun Kyeung Song, PhD, RN Associate Professor, University of Ulsan, College of Medicine, Department of Nursing, Korea. Seok-Min Kang, MD, PhD Professor, Cardiology Division, Yonsei Cardiovascular Center Cardiovascular Research Institute, Severance Hospital, Seoul, Korea.
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.forename: Seok-Min
authors.initials: SM
authors.lastname: Kang
mesh_terms: D000368:Aged; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000517:prevention & control; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D014815:Vitamins; D014807:Vitamin D