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47 - P Forcada - Marzo de 2020

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Enfermedad cardiovascular y depresión: ¿concurrencia o concausa?

farmacología

farmacología cardiovascular 47 | Marzo de 2020 Gráfico 8 Adaptado de cita 32. Perspectivas A lo largo de los últimos veinte años se han ido incluyendo cada vez más los factores de riesgo psicosociales en la evaluación diagnóstica y pronóstico del paciente cardiovascular, dando lugar al origen de subespecialidades tales como Psicocardiología (31) y la Cardiología de la Conducta, esta última una nueva área transdisciplinaria que a través de las neurociencias, del conocimiento de la red alostática y una mayor apertura mental relaciona la Cardiología con la Psiquiatría y las Ciencias Sociales. Sin embargo, aún persiste una barrera entre los factores de riesgo cardiovasculares considerados convencionales y los psicosociales, que aparecen en un segundo plano y por lo general subestimados y que, deberían dar paso a un enfoque más abarcador y transdisciplinario del paciente persiguiendo los mejores resultados para el tratamiento de la enfermedad de base sin perder de vista a la persona y su calidad de vida. El tratamiento de ambas patologías esta interrelacionado y la mejoría de una conlleva el de la otra y un resultado final basado en la concepción integral del paciente mas allá de un enfoque sintomático o fisiopatológico simplista, será la rehabilitación completa del sujeto tanto física, como mental, social e incluso espiritualmente. En ese sentido hay excelentes artículos de revisión en la bibliografía sobre este enfoque integral que abren nuevos horizontes en el enfoque del paciente cardiovascular, y la génesis y evolución de su enfermedad (32). Referencias bibliográficas • 1. Brunner E, et al. Depressive disorder, coronary heart disease, and stroke: dose-response and reverse causation effects in the Whitehall II cohort study. European Journal of Preventive Cardiology 2014 Mar; 21(3): 340-346. • 2. Gump BB, et al. MRFIT Research Group. Depressive symptoms and mortality in men: results from the Multiple Risk Factor Intervention Trial. Stroke. 2005 Jan; 36(1): 98-102. • 3. Ariyo AA, Haan M, Tangen CM, et al. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation 2000;102: 1773–1779. • 4. Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet 2007; 370: 1089–100. • 5. Huang K, Deng X, He D, et al. Prognostic Implication of Earthquake-Related. Loss and Depressive Symptoms in Patients With Heart Failure Following the 2008. Earthquake in Sichuan. Clin. Cardiol. 2011 34, 12: 755–760. • 6. Rozanski A, Blumenthal JA, Davidson KW, et al. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. J. Am. Coll. Cardiol. 2005;45: 637-651. • 7. Samuels M. The Brain - Heart connection. Circulation. 2007;116: 77-84. • 8. Yusuf S, Hawken S, Ôunpuu S, et al. On behalf of the INTERHEART Study Investigators: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–52. 9. O’Donnell M J, Xavier D, Liu L, et al. On behalf of the INTERSTROKE investigators: Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010: 376: 112–123. • 10. Lichtman JH, Bigger, Jr JT, Blumenthal JA, et al. Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment. Circulation 2008;118: 1768-1775. • 11. Lichtman JH, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014; 129 (12): 1350-69. • 12. Rozanski A, Shaw L, Berman DS et al. Do psychological risk factors predict the presence of coronary atherosclerosis? Psychosom Med. 2011 Jan; 73(1): 7-15. • 13. Mc Ewen B. Physiology and Neurobiology of Stress and Adaptation: Central Role of the Brain. Physiol Rev 2007;87: 873–904. • 14. Mc Ewen B.: Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load. Metabolism Clinical and Experimental 55 (Suppl 2) (2006) S20–S23. • 15. Márquez López Mato A. Psiconeuroinmunoendocrinología. 1a. Ed. Ed. Sciens. Buenos Aries. Argentina. 2008. • 16. Cardinali D. Neurociencia Aplicada. 1a. Ed. Ed Panamericana. Buenos Aries. Argentina 2007. • 17. Zubcevic J, Waki H, Raizada MK, Paton JF. Autonomic-Immune-Vascular Interaction: An Emerging Concept for Neurogenic Hypertension. Hypertension 2011, 57: 1026-1033. • 18. Everson SA, Kaplan GA, Goldberg DE, Salonen JT. Hypertension Incidence Is Predicted by High Levels of Hopelessness in Finnish Men. Hypertension. 2000;35: 561-567. • 19. Ried LD, Tueth MJ, Handberg E, et al and the INVEST study group: A Study of Antihypertensive Drugs and Depressive Symptoms (SADD-Sx) in Patients Treated With a Calcium Antagonist Versus an Atenolol Hypertension Treatment Strategy in the International Verapamil SR-Trandolapril Study. Psychosomatic Medicine 2005; 67: 398–406. • 20. Taco B. M. Monster, PhD, Søren P. Johnsen, MD, Mette L. Olsen, et al. Antidepressants and Risk of First-Time Hospitalization for Myocardial Infarction: A Population-Based Case-control Study. Am J Med. 2004;117: 732–737. • 21. Blumenthal JA, Lett HS, Babyak MA, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003;362: 604 –609. • 22. Nemeroff CB, et al. Are platelets the link between depression and ischemic heart disease? Am Heart J. 2000 Oct; 140(4 Supply): 57-62. • 23. Musselman DL, et al. Platelet reactivity in depressed patients treated with paroxetine: preliminary findings.Arch Gen Psychiatry. 2000 Sep; 57(9): 875-82. • 24. Blumenthal JA, Sherwood A, Babyak MA, et al. Exercise and Pharmacological Treatment of Depressive Symptoms in Patients With Coronary Heart Disease. J Am Coll Cardiol 2012;60: 1053–63. • 25. Lespérance F, et al. CREATE Investigators. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial JAMA. 2007 Jan 24; 297(4): 367-79. • 26. Williams SA, Kasl SV Heiat A, et al. Depression and Risk of Heart Failure Among the Elderly: A Prospective Community-Based Study. Psychosomatic Medicine 2002; 64: 6–12. • 27. Shabetai R. Depression and Heart Failure. Psychosomatic Medicine 2002; 64: 13–14. • 28. Kugler C, et al. Association of depression symptoms with quality of life and chronic artery vasculopathy: a cross-sectional study in heart transplant patient’s 2014 Aug; 77(2): 128-134. • 29. Xiong GL, et al. SADHART-CHF Investigators. Health status and depression remission in patients with chronic heart failure: patient-reported outcomes from the SAD- HART-CHF trial. Circ Heart Fail. 2012 Nov; 5(6): 688-92. • 30. Bauer LK, Caro MA, Beach SR, et al. Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients. Am J Cardiol 2012;109: 1266 –1271. • 31. Laham M. Psicocardiología. Abordaje psicológico al paciente cardíaco. Segunda edición ampliada. Ediciones del Instituto de Psicocardiología. Buenos Aires. Argentina. 2010. • 32. Rozanski A. Behavioral Cardiology: Current Advances and Future Directions. J Am Coll Cardiol 2014;64: 100–110. EDITORIAL SCIENS // 9

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