DEBORA SITNIK
Projetos de Pesquisa
Unidades Organizacionais
LIM/20 - LaboratĆ³rio de TerapĆŖutica Experimental, Hospital das ClĆnicas, Faculdade de Medicina
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conferenceObject Association of depression and coronary heart disease in the participants from the strategy of registry in acute coronary syndrome study (the ERICO study)(2012) GOULART, Alessandra C.; SANTOS, Itamar S.; SITNIK, Debora; STANIAK, Henrique L.; BITTENCOURT, Marcio S.; FEDELI, Ligia G.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Introduction: Depression is 3 times more common in patients after acute coronary syndrome (ACS). Further, depressive symptoms and clinical depression have an unfavorable impact on mortality in these patients. The Patient Health Questtionaire-9 (PHQ-9) is a brief depression screening instrument that has been shown reasonable sensitivity and specificity in this group. Objectives: To evaluate the baseline frequency of mild-moderate depressive symptoms, major depression and, their associations to ACS among participants from the ERICO study(Strategy of Registry of Acute Coronary Syndrome). Methods: This is an ancillary study of the ERICO study, an ongoing cohort study held at the University Hospital of the Universityof SaĢo Paulo, a teaching public hospital located in SĆ£o Paulo, Brazil. The ERICO study aims to verify the frequency of ACS and its subtypes, the role of potential risk factors and the long-term event rate. Besides the cardiovascular evaluation, participants are invited to answer PHQ-9 (score range 0 ā27 points). The presence of mild to moderate depressive symptoms was defined as a score from 1 to 9 points. Major depression (MD) was defined as a score of 10 or more points. Results: From September 2009 to January 2011, 452 patients ( 35 years) were diagnosed as having SCA. From 218 patients (mean age 62 years) who answered PHQ-9, 130 (59%) were male. 65 (29.8%) were diagnosed as having unstable angina, 94 (43.1%) as non-ST elevation myocardial infaction (MI) and 59 (27.1%) as ST-elevation MI. Almost 90% had at least one depressive symptom and, the most common complaint was āfelling tired or having little energyā. Major depression was present in 77 (35.3%) ACS patients. MD was more frequent in women than in men (59.7% vs. 40.3%, p<0.001). Almost 50% of married patients had MD (p=0.02). Other sociodemographics factors had no association with clinical depression. ACS subtypes did no nfluency the frequency of depressive symptoms or MD. Conclusion: Compared to previous studies, we found a higher frequency of MD, regardless of ACS subtypes. Follow-up study will address the impact of depressive symptoms and MD in long-term outcomes.conferenceObject Design and baseline characteristics of a coronary heart disease prospective cohort: 2-year experience from the strategy of registry of acute coronary syndrome study (ERICO study)(2012) SANTOS, Itamar S.; GOULART, Alessandra C.; SITNIK, Debora; STANIAK, Henrique L.; FEDELI, Ligia G.; BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Introduction: Acute coronary syndrome (ACS) is an important cause of hospitalization. Although most patients are treated at local hospitals, the vast majority of registry studies are set in tertiary facilities. The ERICO study (Strategy of Registry of Acute Coronary Syndrome) was created to verify the frequency of ACS and its subtypes, the role of known or potential risk factors and long-term event rate in a community teaching hospital in the southeastern region of Brazil. Objectives: To describe the design and baseline characteristics during the two initial years of ERICO enrollment. Methods: The ERICO study is an ongoing prospective cohort. It is conducted at a secondary general hospital in Sao Paulo, Brazil. All consecutive patients, 35 years-old or older, with a diagnosis of ACS who agree to participate are enrolled in the study. Sociodemographics, medical history, clinical exam and information about hospital treatment are obtained. A brief depression questionnaire is also applied for an ancillary study. Blood samples are drawn at admission and stored. In 30-day follow-up visit, data on medical history and occurence of depressive symptoms are updated and additional blood and urinary samples are collected. Retinography, carotid intima-media thickness, heart rate variability and pulse wave velocity are performed. Questionnaires about food frequency, physical activity and sleep apnea are applied. At six months, and annually after acute event, participants are followed by phone. Results: From February 2009 to January 2011, 570 patients were enrolled. Of these, 156 (27.4%) had ST-elevation myocardial infarction (STEMI), 233 (40.9%) non ST-elevation myocardial infarction (NSTEMI) and 181 (31.7%) unstable angina (UA). Median age was 62 (interquartile interval: 54ā73) years. 332 (58.2%) were men and 451 (79.1%) had 8 years or less of education. Most common primary cardiovascular risk factors were hypertension and sedentarism. Among 455 individuals who could adequately inform about previous coronary disease, only 126 (27.7%) had a prior positive history. Compared to the subgroup with STEMI, individuals with UA and NSTEMI had a higher frequency of known hypertension (p<0.01), dyslipidemia (p=0.01), sedentarism (p=0.01), prior coronary heart disease (CHD, p heart failure (p<0.01). Conclusion: In contrast to studies performed in tertiary hospitals, this community-hospital based sample has a less frequent prior history of CHD, which possibly reflects more closely a community-based setting.