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Anxiety and depression: Lifestyle influential in MACE prevention

Presented by
Dr Shady Abohashem, Massachusetts General Hospital, USA
ACC 204
Mass General Brigham Biobank
Pursuing a favourable lifestyle may have a greater impact on the risk of major adverse cardiovascular events (MACE) in people with anxiety and/or depression than in those without. A healthy lifestyle was also associated with neuro-inflammatory changes.

The presented retrospective cohort study included 37,383 individuals from the Mass General Brigham Biobank from 2010–2020 [1]. In this cohort, Dr Shady Abohashem (Massachusetts General Hospital, MA, USA) and colleagues assessed the efficacy of lifestyle factors, measured by a lifestyle score, on the risk of cardiovascular disease (CVD) in people with and without anxiety and/or depression. The study also evaluated neuro-inflammatory markers like stress-related neural activity. The primary endpoint was a lifestyle score named LS (A) that was calculated as a composite of favourable lifestyle behaviours: exercise at ≥500 metabolic equivalents of task (METs)/week, average sleep of 7–9 hours daily, and alcohol of 1–14 units/week.

In a Cox model that adjusted for CVD risk factors, an overall lower chance of MACE (i.e. myocardial infarction, unstable angina, or stroke) was associated with the highest score category of lifestyle over 10 years (HR 0.53; 95% CI 0.48–0.59). Also, each change of lifestyle category was linked to a reduced risk of MACE (HR 0.82; 95% CI 0.79–0.84). Assessing people without versus people with anxiety and/or depression showed a greater decrease in risk for people with anxiety and/or depression, translating into an additional relative risk reduction of 64% with a P<0.001 for effect modification.

In a subset of individuals with data on neuro-immune measures, LS (A) was linked to a graded reduction in stress-related neural activity on FDG PET/CT imaging. For heart rate variability and C-reactive protein, significant associations to LS (A) were also observed. A mediation analysis further suggested that the neuro-inflammatory pathways may be partially involved in the benefit of a favourable lifestyle. Future research investigating measures of lifestyle modification could be specifically beneficial to individuals with anxiety and/or depression by providing preventive recommendations for this population.

    1. Abohashem S, et al. Lifestyle behaviours associate with greater reduction in cardiovascular disease risk among people with anxiety and/or depression: mediated by a reduction in stress related brain activity. Session 910-05, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

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