Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study

Background. Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications.

Purpose. The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation.

Materials and methods. This multicenter cross-sectional study was conducted in 2016–2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D. Results. Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % – felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning.

Conclusion. In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

1. Neylon A., Canniffe C., Anand S. et al. A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis 2013;55 (6):574–581.

2. Rozanski A. Psychosocial risk factors and cardiovascular disease: tpidemiology, screening, and treatment considerations. Cardiovascular Innovations and Applications 2016;1 (4):417–431.

3. Piepoli M. F., Hoes A. W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37 (29):2315–2381. DOI: 10.1093/eurheartj/ehw106. Epub 2016 May 23.

4. Boytsov S. A., Pogosova N. V. et al. Editorial a. CARDIOVAS CULAR PREVENTION 2017. NATIONAL GUIDELINES. Russian Journal of Cardiology. 2018; (6):7–122. Russian https://doi.org/10.15829/1560-4071-2018-6-7-122

5. Pogosova N., Saner H., Pedersen S. S. et al. Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2015;22 (10):1290–1306.

6. Rosengren A., Hawken S., Ounpuu S. et al., for the INTERHEART investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:953–962.

7. Pogosova N. V., Boytsov S. A., Oganov R. G. et al. on Behalf of Investigators From 30 Centers in Russia. Clinical-Epidemiological Program of Studying Psychosocial Risk Factors in Cardiological Practice in Patients With Arterial Hypertension and Ischemic Heart Disease: First Results of a Multicenter Study in Russia. 2018;9 (58);47–58. Russian

8. Zigmond A. S., Snaith R. P. Hospital Anxiety and Depression Scale. Acta Psychiat Scand 1983;67:361–370.

9. Denollet J. DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med 2005;67:89–97.

10. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008;358:2468–2481

11. Gerber Y., Goldbourt U., Drory Y. Interaction between income and education in predicting long-term survival acute myocardial infarction. Eur J Cardiovasc Prev Rehabil 2008;15:526–532.

12. Pogosova G. V., Koltunov I. E., Sokolova O. J. Secondary prevention of hypertension and coronary heart disease in clinical practice of the Russian Federation. M: VikasPrint 2009;154. Russian

13. Pogosova N. V., Oganov R. G., Boytsov S. A. et al. Monitoring the Secondary Prevention of Ischemic Heart Disease in Europe and Russia: Results of the Russian Part of the International Multicenter Study EUROASPIRE IV. Cardiology 2015;55 (12):99–107. Russian

14. Social Status and Standard of Living of the Russian Population. Rosstat. M 2017;332. Russian (Социальное положение и уровень жизни населения России. 2017: Стат. сб. Росстат. M 2017;332).

15. Tucker J., Lowell C. National snapshot: Poverty among women & families, 2015 Retrieved from https://nwlc.org/wp-content/uploads/2016/09/Poverty-Snapshot-Factsheet-2016.Pdf

16. Barth J., Schneider S., von Kanel R. Lack of social support in the etiology and the prognosis of coronary heart disease: A systematic review and meta-analysis. Psychosom Med 2010;72:229–238.

17. Chung M. L., Moser D. K., Lennie T. A. et al. Perceived social support predicted quality of life in patients with heart failure, but the effect id mediated by depressive symptoms. Qual Life Res 2013;22:1555–1563.

18. Saito M., Kondo N., Kondo K. et al. Gender differences on the impacts of social exclusion on mortality among older Japanese: AGES cohort study. Soc Sci Med 2012;75 (5):940–945. DOI: 10.1016/j.socscimed.2012.04.006. Epub 2012 May 14.

19. Knoll N., Schwarzer R. Gender and Age Differences in Social Support: A Study of East German Migrants. In: Weidner G., Kopp M., Kristenson M., editors. Heart disease: Environment, stress, and gender. Amsterdam: IOS Press; 2002. pp. 198–210.

20. Georgiades A., Janszky I., Blom M. et al. Financial strain predicts recurrent events among women with coronary artery disease. Int J Cardiol 2009;135:175–183.

21. Berntson J., Patel J. S., Stewart J. C. Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder. J Psychosom Res 2017;99:149–154. DOI: 10.1016/j.jpsychores.2017.06.008. Epub 2017 Jun 12.

22. Oganov R. G., Pogosova G. V., Koltunov I. E. et al. Depressive Symptoms Worsen Cardiovascular Prognosis and Shortens Length of Life in Patients With Arterial Hypertension and Ischemic Heart Disease 2011;51 (2):59–66. Russian

23. Sogaro E., Schinina F., Burgisser C. et al. Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation. Monaldi Arch Chest Dis 2010;74:181–191.

24. Condén E., Leppert J., Ekselius L., Åslund C. Type D personality is a risk factor for psychosomatic symptoms and musculoskeletal pain among adolescents: a cross-sectional study of a large population-based cohort of Swedish adolescents. BMC Pediatrics 2013;13:1471–2431.

25. Kupper N., Pedersen S. S., Höfer S. et al. Crosscultural analysis of Type D (distressed) personality in 6222 patients with ischemic heart disease: A study from the International HeartQoL Project. International Journal of Cardiology 2013;166:327–333.

26. Zhang Y., Chen Y., Ma L. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci 2018;47:1–5. DOI: 10.1016/j.jocn.2017.09.022. Epub 2017 Oct 21.

27. Pogosova N., Kotseva K., De Bacquer D. et al. Psychosocial risk factors in relation to other cardiovascular risk factors in coronary heart disease: Results from the EUROASPIRE IV survey. A registry from the European Society of Cardiology. Eur J Prev Cardiol 2017;24 (13):1371–1380. DOI: 10.1177/2047487317711334. Epub 2017 May 23. PMID: 28534422

28. Altemus M., Sarvaiya N., Epperson C. N. Sex differences in anxiety and depression clinical perspectives. Frontiers in neuroendocrinology. 2014;35 (3):320–330. DOI:10.1016/j.yfrne. 2014.05.004

29. Chazov E. I., Oganov R. G., Pogosova G. V. et al. Clinico-Epidemiological Program of the Study of Depression in Cardio logical Practice in Patients With Arterial Hypertension and Ischemic Heart Disease (COORDINATA). Cardiology 2007;47 (3):28–37. Russian