Medical Bulletin 20/ June/ 2024

According to research published in the European Heart Journal, women diagnosed with perinatal depression are more likely to develop cardiovascular disease in the following 20 years compared to women who have given birth without experiencing perinatal depression.

Perinatal depression, meaning depression during pregnancy or after birth is believed to affect one in five women giving birth worldwide.

This condition can lead to persistent stress and inflammation, adversely impacting the cardiovascular system. Additionally, women experiencing perinatal depression may be less likely to engage in healthy behaviours, such as regular exercise and proper nutrition, further exacerbating their risk. The combination of psychological stress and potential lifestyle changes creates a higher likelihood of developing heart disease.

The study is the first of its kind to look at cardiovascular health after perinatal depression.

The study was based on the Swedish Medical Birth Register and compared 55,539 women who were diagnosed with perinatal depression between 2001 and 2014 with another group of 545,567 women who had also given birth during that time but were not diagnosed with perinatal depression. All the women were followed up through to 2020 to assess if they developed any cardiovascular disease.

The results showed that among the women with perinatal depression, 6.4% developed cardiovascular disease compared to 3.7% of women who had not suffered with perinatal depression. This equates to a 36% higher risk of developing cardiovascular disease. Their risk of high blood pressure was around 50% higher, the risk of ischemic heart disease around 37% higher, and the risk of heart failure around 36% higher.

“Our findings may help identify individuals at higher risk of cardiovascular disease, allowing for preventive measures. This study highlights the additional health risks associated with perinatal depression, which is both preventable and treatable. Many experience their first episode of depression during this time, underscoring the need for holistic maternal care that addresses both physical and mental health. While the exact pathways linking perinatal depression to cardiovascular disease remain unclear, further research is needed to understand and effectively prevent both conditions,” said senior author Dr Bränn.

Reference: Donghao Lu, Unnur A Valdimarsdóttir, Dang Wei, Yufeng Chen, Ole A Andreassen, Fang Fang, Krisztina D László, Emma Bränn, Perinatal depression and risk of maternal cardiovascular disease: a Swedish nationwide study, European Heart Journal, 2024;, ehae170, https://doi.org/10.1093/eurheartj/ehae170

According to a study published in the journal Nature communications, the over-the-counter supplement nicotinamide riboside, a form of vitamin B3, increased the walking endurance of patients with peripheral artery disease, a chronic leg condition for which there are few effective treatments.

Peripheral artery disease affects approximately 200 million people worldwide over the age of 40. Caused by the buildup of fatty deposits in arteries, and associated with diabetes and smoking, the disease reduces blood flow to the limbs, especially the legs.

Walking often becomes painful, and the disease typically causes declines in walking ability over time. Supervised walking exercise is first line therapy for Peripheral artery disease, but most people with the condition do not have access to supervised exercise.

In the study, scientists recruited 90 individuals with an average age of 71 who had peripheral artery disease (PAD) to test the effects of nicotinamide riboside. Nicotinamide riboside is a precursor to NAD, an essential compound involved in energy generation, improved blood flow, and DNA repair. Given that PAD is associated with difficulties in energy production within muscle cells, researchers hypothesized that nicotinamide riboside, by enhancing energy generation, could improve walking ability in people with the disease.

The results showed that participants taking the supplement walked an average of 23 feet more in a six-minute walking test after six months, while those taking a placebo walked 34 feet less. Those who took at least 75% of the pills they were supposed to take performed even better, adding more than 100 feet to their walking distance, compared to people who took a placebo.

“This is a signal that nicotinamide riboside could help these patients. We are hoping to conduct a larger follow-up trial to verify our findings. We need to test it on a healthy older population before we recommend healthy people take it,” said the authors.

Reference: McDermott, M.M., Martens, C.R., Domanchuk, K.J. et al. Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial. Nat Commun 15, 5046 (2024). https://doi.org/10.1038/s41467-024-49092-5

An investigation by researchers from the Faculty of Nursing and Podiatry at the University of Valencia showed the close relationship between childhood sleep disorders and the development of ADHD symptoms in preadolescence.

The study, published in the European Journal of Pediatrics, represented important progress in understanding the causes of ADHD, a neurodevelopmental disorder affecting around 7.5% of children.

Sleep is a complex physiological state, partly responsible for physical and mental performance. Disorders affecting it have immediate and far-reaching consequences.

Sleep disorders in children can lead to symptoms of ADHD, such as trouble paying attention and being overly active. Poor sleep affects the brain's ability to function properly, making it harder for children to concentrate and control their impulses. Over time, this can result in behaviours that are similar to those seen in ADHD, like difficulty focusing, restlessness, and hyperactivity.

Several studies have previously shown that sleep disorders and ADHD are common during childhood, with a prevalence of 20% for sleep disorders and 3-7.5% for ADHD. Sleep disorders are more prevalent in children with ADHD, affecting between 25% and 73.3% of them.

For the study, the research team worked with 1,244 boys and girls, more specifically, the cohorts participating in the INMA project. On the one hand, they assessed sleep disorders at the age of 8 or 9 using the Child Behavior Checklist (CBCL) for ages 6-18 and, on the other, they examined manifestations of ADHD using the Conners Parent Rating Scale (CPRS-R:S).

The researchers established a strong relationship between sleep disorders at the ages of 8 and 9 and the development of ADHD symptoms at the ages of 10 and 11.

The association between sleep disorders and ADHD symptoms was maintained after excluding from the initial analysis children who had shown previous clinical problems (for example, those born small for their gestational age, premature babies, and those who had symptoms compatible with an ADHD diagnosis either before and at the same time as the appearance of sleep disorders). This highlighted the strength of the association between sleep disorders and ADHD.

Reference: González-Safont, L., Rebagliato, M., Arregi, A. et al. Sleep problems at ages 8–9 and ADHD symptoms at ages 10–11: evidence in three cohorts from INMA study. Eur J Pediatr (2023). https://doi.org/10.1007/s00431-023-05145-3