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Background: Obesity and depression both individually contribute to the risk of Type II Diabetes (T2DM). The extent to which obesity can be set-off by depression is unknown.Methods: In a sample of 9340 participants followed for 15.4 years (79,372 person-years) from the prospective MONICA/KORA population-based cohort conducted in Southern Germany, we investigated the impact of obesity, defined as Body Mass Index (BMI) _a 30, and depression on the incidence of T2DM using Cox Proportional Hazards Regression.Results: The relative risk of T2DM was over 6 fold higher among obese participants in comparison to normal weight participants (HR 6.05; 95% CI 4.82 to 7.59; p

Background The role of an individual’s social network satisfaction (SNS) in the association of social isolation or living alone and incident type 2 diabetes (T2D) is unclear. We assessed the association of SNS with incident T2D and analysed potential modifications of the SNS-T2D association by social isolation or living alone. Methods The study population (N = 6839 aged 25–74 years without diabetes at baseline) derived from the prospective population-based MONICA/KORA study (1989–2009). Social network satisfaction was assessed by a single item. Cox regression was used to estimate hazard ratios (HR) for SNS separately in men and women. Results In men with low SNS, risk for incident T2D increased significantly (HR: 2.15, 95% CI: 1.33–3.48, p value 0.002). After additional adjustments for social isolation or living alone, the risk for incident T2D was still significant, albeit less pronounced (HRs 1.85 or 2.05, p values 0.001 or 0.004). The interaction analysis showed an increased T2D risk effect for low SNS compared to high SNS in women living in a partnership (HR: 2.11, 95% CI: 1.00–4.44, p value for interaction: 0.047) and for moderate SNS compared to high SNS in socially connected women (1.56, 1.01–2.39, 0.010). Conclusions Further research is needed to address the complexities of the perception of social relationships and social interactions, or interdependence, especially when another major public health issue such as T2D is concerned. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4323-7) contains supplementary material, which is available to authorized users.

Aim To investigate the association between anxiety symptoms and the progression from prediabetes to type 2 diabetes. Methods A sample of 1708 participants aged 31-82 years from the population-based Cooperative Health Research in the Region of Augsburg F4 and the follow-up Cooperative Health Research in the Region of Augsburg FF4 studies was included. Prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance, and anxiety status was measured by the generalized anxiety disorder-7 questionnaire. Newly diagnosed type 2 diabetes cases were identified after 6.5 years (11 102 person-years) and confirmed by medical records. Multivariate logistic regression analyses were employed to estimate the effect of prediabetes and anxiety on the incidence of type 2 diabetes with different levels of adjustments for potential confounders. The population attributable risk of type 2 diabetes in participants with prediabetes and anxiety was estimated. Results Prediabetes at baseline was prevalent in 247 participants, of whom 77 developed diabetes after follow-up, accounting for a progression rate of 31%. In participants with prediabetes, high anxiety was associated with a 3-fold increased risk of progression to type 2 diabetes in comparison with low anxiety, even after accounting for socio-demographic, lifestyle and metabolic risk factors (OR = 2.82, 95% CI = 0.95-8.37, P = 0.06). A significant proportion of incident type 2 diabetes was attributed to having anxiety in addition to prediabetes (attributable risk proportion: 0.52; 95% CI = 0.004-1.04, P = 0.05). Conclusions Anxiety symptoms independently increase the progression risk of prediabetes to type 2 diabetes and should be routinely considered alongside the traditional risk factors in people with prediabetes.

Objective We aimed to assess whether patients' knowledge about acute myocardial infarction (AMI) has an impact on the prehospital delay-time. Methods This investigation was based on 486 AMI patients who participated in the cross-sectional Munich-Examination-of-Delay-in-Patients-Experiencing-Acute-Myocardial-Infarction (MEDEA) study. A modified German-version of the ACS-Response-Index Questionnaire was used. Multivariate logistic-regression models were used to identify factors associated with knowledge-level as well as the impact of knowledge-level on delay-time. Results High AMI-knowledge shortened median delay-time in men (168[92–509] vs. 276[117–1519] mins, p =0.0069), and in women (189[101–601] vs. 262[107–951]mins, p =0.34). Almost half-of-patients (n=284,58%) demonstrated high AMI-knowledge. High-knowledge were independently associated with male-gender ( OR = 1.47[1.17–1.85]) and General-Practitioner as a knowledge-source ( OR = 1.42[1.14–1.77] ). Old-age ( OR = 0.87[0.86–0.89] ) and previous AMI-history/stent-placement ( OR = 0.65[0.46–0.93] ) were significantly associated with lower-knowledge. Although the majority (476,98%) correctly recognized at least one AMI-symptom, 69(14.2%) patients correctly identified all AMI-symptoms. Additionally, one-in-three believed that heart-attack is always accompanied with severe chest-pain. Elderly-patients and women were more likely to be less-knowledgeable about atypical-symptoms ( p =0.006), present with atypical AMI-presentation ( p p Conclusions Knowledge of AMI-symptoms remains to be substandard, especially knowledge of atypical-symptoms. Knowledge is essential to reduce delay-times, but it is not a panacea, since it is not sufficient alone to optimize prehospital delay-times.

Background: Exposure to ambient air pollution may be associated with impaired mental health, including depression. However, evidence originates mainly from animal studies and epidemiological studies in specific subgroups. We investigated the association between air pollution and depressed mood in four European general population cohorts.Methods: Data were obtained from LifeLines (the Netherlands), KORA (Germany), HUNT (Norway), and FINRISK (Finland). Residential exposure to particles (PM2.5, PM(2.5)absorbance, PM10) and nitrogen dioxide (NO2) was estimated using land use regression (LUR) models developed for the European Study of Cohorts for Air Pollution Effects (ESCAPE) and using European wide LUR models. Depressed mood was assessed with interviews and questionnaires. Logistic regression analyses were used to investigate the cohort specific associations between air pollution and depressed mood.Results: A total of 70,928 participants were included in our analyses. Depressed mood ranged from 1.6% (KORA) to 11.3% (FINRISK). Cohort specific associations of the air pollutants and depressed mood showed heterogeneous results. For example, positive associations were found for NO2 in LifeLines (odds ratio [OR] = 1.34; 95% CI: 1.17, 1.53 per 10 mu g/m(3) increase in NO2), whereas negative associations were found in HUNT (OR= 0.79; 95% CI: 0.66, 0.94 per 10 mu g/m(3) increase in NO2).Conclusions: Our analyses of four European general population cohorts found no consistent evidence for an association between ambient air pollution and depressed mood. (C) 2015 Elsevier GmbH. All rights reserved.

Background Scarce evidence yields conflicting results regarding the effect of prodromal chest pain (PCP) on pre-hospital delay during an acute myocardial infarction (AMI). We aimed to assess the impact of PCP on delay. Methods Data was collected on 619 ST-elevated MI patients from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Patients with any PCP (which was subdivided into undefined PCP, possible and definite angina) within a year before AMI were identified using the Rose questionnaire, administered in bedside interviews. The influence of PCP and its subdivisions (all compared to no PCP) was assessed using logistic regression (with cut-offs of 2h, 6h, and a 4-category ordinal outcome). Results Any type of PCP was reported by men (50.6%) more than women (34.6%) (OR=1.9; 95% CI: 1.3 to 2.8; p=.001). The median delay of patients with PCP was not significantly different to delay in patients with no PCP (p=.327). Prolonged delay times were observed in women with PCPs of lesser degree of cardiac confirmation, while the opposite was observed in men. In women, possible angina was more strongly associated with delay Conclusions For men, PCPs of increasing cardiac confirmation are associated with prolonged delay. For women, PCPs of lesser cardiac confirmation are more likely to lead to prolonged delay. Future studies should investigate mediating factors.

This study compares health-related quality of life (HRQL) in patients with type 2 diabetes (T2DM) across treatment groups and explores gender differences.Four regional surveys (KORA, CARLA, SHIP, DHS) and a national survey (GNHIES98) were pooled at individual level. HRQL was assessed with the SF-12/-36v1. Linear regression models were used to assess the effect of T2DM by treatment type (no medication; oral; oral/insulin combination; insulin) on the physical (PCS-12) and mental summary score (MCS-12) and the SF-6D, controlling for age, sex, study and covariates. We also performed an explanatory analysis of single items.PCS-12 scores and treatment type were associated (P-value 0.006), with lowest values for insulin treatment (-4.44 vs. oral; -4.41 vs. combination). MCS-12 scores were associated with treatment type and gender (P-value0.012), with lower scores for women undergoing oral (-4.25 vs. men) and combination treatment (-6.99 vs. men). Similar results were observed for SF-6D utilities and single items, related to mental health, social functioning, vitality and role limitation (emotional). Comorbidities were predictors of lower PCS-12 and SF-6D scores.T2DM treatment impacts differently on physical and mental HRQL and on women and men. Further studies of gender-specific perceptions of T2DM treatment regimens are needed.

Description of study population. (DOCX 18Â kb)

Summary Context Preliminary evidence points to aldosterone being not only prominently involved in the systemic regulation of the blood pressure but also to play a role in the pathophysiology of depression. Objective We evaluated whether the combination of hypertension and depressed symptomatology is useful to screen for individuals suffering an activation of the renin–angiotensin–aldosterone system (RAAS). Design We conducted a cross-sectional analysis in participants from the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study conducted between 2006 and 2008 in Southern Germany. A total of 1805 participants of the F4 study were included in the study. Methods The association between aldosterone and renin levels and the different combinations of hypertension and depressed symptomatology was examined in four different models of multiple linear regression adjusted for age, sex, creatinine levels, potassium levels, body mass index (BMI) and behavioural risk factors. Results Individuals suffering both, depressed symptomatology and hypertension exhibited highly significantly increased aldosterone levels ( p p = 0.08) compared to individuals with no depressed symptomatology and no hypertension. No significant activation of the RAAS was seen in only depressed or only hypertensive individuals. Conclusions The finding of highly significantly increased aldosterone levels and increased renin levels in individuals suffering both, depressed symptomatology and hypertension provides further evidence for the involvement of the RAAS in the pathogenesis of depressed symptomatology. These findings have important implications for future research concerning the pathophysiological pathways that link depression and cardiovascular disease.

Objective During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. Methods This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers. Results Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196). Conclusions Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.

BACKGROUND: Chronic pain is frequent in elderly people and, especially if widespread, associated with poor mental health. We investigated whether a resilient personality protects older adults against the adverse effects of chronic pain. METHODS: Pain status [no pain, chronic local pain (CLP) and chronic widespread pain (CWP)] was determined using the American College of Rheumatologists' criteria for widespread pain in a cross-sectional sample of 724 participants aged 68-92years drawn from the population-based KORA-Age study in Southern Germany. Depressive symptoms and resilience were assessed via the scales GDS-15 and RS-5. The relation between pain, resilience and depressive symptoms was modelled using logistic and quantile regression. RESULTS: CLP prevalence and CWP prevalence were 57.5% and 12.3%, respectively. Confounder-adjusted logistic regression indicated a fourfold risk of depressed mood (GDS-15≥5) in CWP, vs. no pain (OR=4.08, 95% CI 1.90-8.74). However, in quantile regression, the adverse effect of CWP was significantly attenuated by resilience when looking at the GDS-15 score lower quartile (p=0.011) and median (p=0.011). This effect appeared to be mainly driven by participants aged 75-84years. Confounder adjustment reduced the effect of CLP on depressive symptoms to non-significance, and effect modification by resilience was undetectable in regression models of CLP. CONCLUSIONS: Resilience was protective in the association of CWP with depressive symptoms in this analysis. Older adults with CWP may potentially benefit from interventions supporting resilience. Prospective research should investigate the protective role of resilience in the potentially self-perpetuating relation between chronic pain and depressed affect. WHAT DOES THIS STUDY ADD?: The association of chronic widespread pain with depressive symptoms in the elderly population is attenuated by resilience.

The renin-angiotensin-aldosterone-system (RAAS) is one of the most important systems involved in the pathogenesis of cardiovascular diseases. Its role in stress response has been generally neglected, although the progression of cardiovascular disease is considerably increased in the presence of stress and especially in the presence of depression risk. With the present analysis we aimed to evaluate whether the activity of the RAAS correlates with depressive symptomatology and with chronic stress. Moreover, we aimed to analyse whether stress response is altered in the presence of depressed symptomatology. We chose "living alone" to be our paradigm of chronic stress.Aldosterone and renin levels were assessed in 1743 (829 men, 914 women) from the population-based KORA study (Cooperative Health Research in the Region of Augsburg). The relationship between aldosterone, renin levels and the different combinations of living alone and depressive symptomatology was examined in three different multiple linear regression models adjusted for age, sex, creatinine levels, potassium levels, body mass index (BMI) and bio-behavioural factors. Neither "living alone" nor depressive symptomatology alone were associated with an activation of the RAAS, but the combination of living alone and depressive symptomatology yielded a highly significant increase in the aldosterone (p0.01) and renin level (p=0.03).Our findings show that depressive symptomatology is associated with a hyper-responsiveness to chronic stress. Under the condition of chronic stress depressed individuals have an activated RAAS. Activation of the RAAS might explain the known increased risk of negative cardiovascular disease outcomes in this group.

Introduction Higher age is related to higher numbers of accumulated health deficits. However, to date it remains unclear how much of this association is due to age effects, how much is contributed by birth cohort effects and if a general trend of compression or expansion of morbidity can be assumed. The objective of this study was to investigate the role of cohort effects with regard to health deficit accumulation (DA) trajectories in people aged 65 and older. Methods Data originates from the baseline assessment of participants aged 65–71 years in 2008 (i.e. born 1937 to 1943) from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany as well as from an independent assessment in 2015 consisting of a younger birth cohort (aged 65–71 years in 2015, i.e. born 1944 to 1950). All participants were former participants of the population representative MONICA/KORA surveys conducted between 1984 and 2001. DA was measured with a Frailty Index (FI). This KORA-Age FI includes in total 33 items, covering 10 diseases, 13 measures of functioning and 10 signs and symptoms. All deficit items were coded as values between 0 (deficit absent) and 1 (deficit fully present). The FI for a person results as the number of the person-specific deficits divided by the total number of listed deficits. Thus, FI scores range from 0 (= no deficits present) to 1 (= all deficits present). If a participant scored missing on one or more of the deficit items, the denominator of the FI was reduced accordingly. Age-specific mean FI scores were graphically presented separately for the younger (born 1944 to 1950) and the older birth cohort (born 1937 to 1943), stratified by sex. The effects of birth cohort, age and sex (all coded as factor variables) on FI levels were analyzed using a generalized linear model (GLM) with the number of present health deficits as negative binomially distributed outcome and the number of possible health deficits as offset term. Significance level was set to 0.05. Results FI values were available for 1919 participants aged 65–71 years in 2008 (51% female) and for 1456 participants aged 65–71 years in 2015 (53% female). Participants from the younger birth cohort aged 65–71 years in 2015 had average FI values (FI = 0.141) comparable to participants from the older birth cohort aged 65–71 years in 2008 (FI = 0.136, P = 0.1071). Plotting birth cohort and sex-specific FI averages by age revealed that both birth cohorts started at the same FI levels, but thereafter, age-specific FI values were higher for the younger birth cohort and for women, specifically for those born in 1944 and 1945. These results were partly confirmed by the GLM. Higher age, especially for those aged 70 (RR: 1.23, KI [1.13; 1.34]) and those aged 71 years (RR: 1.23, KI [1.14; 1.34]) as compared to those aged 65 years, was associated with higher FI values. Also female sex (RR: 1.14, KI [1.09; 1.19]) was independently, significantly and positively associated with higher FI values. Having been born 1944–50 (RR: 1.04, KI [1.00; 1.09]) was positively associated with higher FI values, but the effect was not significant (P = 0.059926). Conclusion Based on our comparison of adults of the same age from different birth cohorts, an expansion of morbidity cannot fully be excluded. This seems to be largely due to the comparatively high levels of deficit accumulation for women born in 1944 and 1945, which coincides with the last years of World War II. Further research is warranted to investigate how specific life course experiences including deprivation in critical developmental periods for these cohorts may have contributed to these effects.

The prevalence of migraine and tension-type headache (TTH) varies considerably with respect to gender, age group and geographic regions. Methodological differences in the assessment and classification of cases are a major cause of this variability across studies, limiting the ability to perform true regional comparisons. We conducted three population-based studies in different German regions and assessed headache prevalence and headache characteristics in face-to-face interviews, applying standardized methods. We analysed the 6-month prevalence of migraine, TTH and their probable subtypes based on the new criteria of the International Headache Society (IHS). Among the 7417 participants in all three regions, the pooled 6-month prevalence of migraine, probable migraine, TTH and probable TTH was 6.75, 4.40, 19.86 and 11.61%, respectively. Despite the application of standardized classification methods, regional variations between 4.39 and 8.00% for migraine and 15.44 and 23.64% for TTH were observed, indicating differences in the local headache burden. Application of the new IHS criteria yielded headache categories that were not mutually exclusive, indicating a need for further discussion about the value of probable headache types in epidemiological studies.

Wachsende Evidenz fur eine Interaktion zwischen dem Ausbruch und dem Voranschreiten einer Vielzahl von kardialen Erkrankungen mit psychosozialen Faktoren hat die Klinische Kommission der DGK dazu bewogen, ein Positionspapier zu diesem Gegenstandsbereich anzuregen. In einem formalisierten Expertenrating wurden von den 10 teilnehmenden Experten die fur die Fragestellung relevanten Subdisziplinen, in denen gegenwartig eine kritische Masse umsetzungsrelevanten psychokardiologischen Wissens vorhanden ist, ermittelt, die Evidenz zusammengetragen und bewertende Schlussfolgerungen fur die Praxis gezogen. Komorbide psychosoziale Parameter im Kontext der koronaren Herzerkrankung (KHK) erreichten die groste Aufmerksamkeit mit I-A-Empfehlungen fur ein Depressionsscreening im Vorfeld und Verlauf der KHK; der Notwendigkeit zur Einbeziehung psychosozialer Konzepte in Strategien zur Verkurzung der Prahospitalzeit sowie fur die Empfehlung einer routinemasigen (Mit-)Behandlung psychosozialer Belastungsfaktoren in der Sekundarpravention der KHK. Eine weitere I-A-Empfehlung konnte fur die Einbeziehung psychologischer Belastungsfaktoren in die Bewertung von Therapieverlaufen von ICD-Patienten ausgesprochen werden. Weitere relevante Aufgabenfelder beziehen sich auf die Herzinsuffizienz und das Verhalten bei Herzoperationen. Insgesamt ist die Evidenzbasierung fur die therapeutische Umsetzung schwacher als fur Diagnostik und Fruherkennung. Das Positionspapier formuliert eine Reihe von konkreten Anwendungsfeldern mit hoher Prioritat fur die Einbeziehung psychosozialer Faktoren in die kardiologische Praxis, die eine leitlinienkonforme Evidenz aufweisen. Forschungsdefizite existieren weiterhin fur die Bewertung der Wirksamkeit von psychotherapeutischen Konzepten bei kardialen Patienten. Curricula fur die Vermittlung von (psycho)diagnostischer, kommunikativer und differenzialdiagnostischer Kompetenz mussen rasch entwickelt werden, um eine Transmission des aktuellen Wissensstandes in die Alltagspraxis zu ermoglichen.

AIMS: Several psychosocial factors have been shown to increase the risk of Type2 diabetes mellitus. This study investigated the association between structural social support and incidence of Type2 diabetes mellitus in men and women. METHODS: Data were derived from three population-based MONICA/KORA surveys conducted in 1984-1995 in the Augsburg region (southern Germany) and followed up by 2009. The study population comprised 8952 participants (4669 men/4283 women) aged 30-74years without diabetes at baseline. Structural social support was assessed using the Social Network Index. Sex-specific hazard ratios were estimated from Cox proportional hazard models. RESULTS: Within follow-up, 904 incident Type2 diabetes mellitus cases (558 men, 346 women) were observed. Crude incidence rates for Type2 diabetes mellitus per 10000person-years were substantially higher in poor compared with good structural social support (men: 94 vs. 69, women: 58 vs. 43). After adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, hypertension, dyslipidaemia, BMI, education, sleep complaints and depressed mood, risk of Type2 diabetes mellitus for participants with poor compared with good structural social support was 1.31 [95% confidence interval (CI)=1.11-1.55] in men and 1.10 (95% CI=0.88-1.37) in women. Stratified analyses revealed a hazard ratio of 1.50 (95% CI=1.23-1.83) in men with a low level of education and 0.87 (95% CI=0.62-1.22) in men with a high level of education (P for interaction: 0.0082). CONCLUSIONS: Poor structural social support is associated with Type2 diabetes mellitus in men. This association is independent of risk factors at baseline and is particularly pronounced in men with a low level of education.

Fear of death (FoD) is an exceptionally stressful symptom of ST-elevation myocardial infarction (STEMI), which received little scientific attention in recent years. We aimed to describe the prevalence and factors contributing to FoD among STEMI patients and assess the impact of FoD on prehospital delay. This investigation was based on 592 STEMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. Multivariate logistic regression models were used to identify factors associated with FoD. A total of 15 % of STEMI patients reported FoD (n = 88), no significant gender difference was found. STEMI pain strength [OR = 2.3 (1.4–3.9)], STEMI symptom severity [OR = 3.7 (2–6.8)], risk perception pre-STEMI [OR = 1.9 (1.2–3.2)] and negative affectivity [OR = 1.9 (1.2–3.1)] were independently associated with FoD. The median delay for those who experienced FoD was 139 min compared to 218 min for those who did not (p = 0.005). Male patients with FoD were significantly more likely to delay less than 120 min [OR = 2.11(1.25–3.57); p = 0.005], whereas in women, this association was not significant. Additionally, a clear dose–response relationship between fear severity and delay was observed. Male FoD patients significantly more often used emergency services to reach the hospital (p = 0.003). FoD is experienced by a clinically meaningful minority of vulnerable STEMI patients and is strongly associated with shorter delay times in men but not in women. Patients’ uses of emergency services play an important role in reducing the delay in male FoD patients.

Little is known about the association between muscle strength and inflammation in diseased individuals and particularly in cardiac patients. Thus, our purpose was to examine the association of muscular strength with the inflammatory status in older adults with and without cardiac disease. The cross-sectional analysis was based on 1079 adults aged 65-94 years, who participated in the KORA-Age study. Participants underwent an interview and extensive physical examinations including anthropometric measurements, registration of diseases and drug intake, determination of health-related behaviors, collection of blood samples for measurements of interleukin-6 and hs-CRP and muscle strength measurement using hand-grip dynamometry. Cardiac patients (n = 323) had higher levels of IL-6 and poorer muscle strength compared with older adults without cardiac disease. Among persons with cardiac diseases, muscle strength in the lower tertile compared to the upper tertile was significantly associated with increased odds of having elevated IL-6 levels (OR 3.53, 95 % CI 1.18-10.50, p = 0.024) after controlling for age, gender, body fat, alcohol intake, smoking status, diseases, medications and physical activity, whereas the association between muscle strength and hs-CRP remained borderline significant (OR 2.80, 95 % CI 0.85-9.24, p = 0.092). The same trends, with slightly lower odds ratios, were also observed in older adults without cardiac disease. Lower levels of muscular strength are associated with higher concentrations of IL-6 and hs-CRP in elderly individuals with and without cardiac disease suggesting a significant contribution of the muscular system in reducing low-grade inflammation that accompanies cardiac disease and aging.

Despite the fact that mitochondrial dysfunctions are increasingly recognized as key components in stress-related mental disorders, very little is known about the association between posttraumatic stress disorder (PTSD) and mitochondrial variants. To identify susceptibility mitochondrial genes for PTSD, we analyzed a total number of 978 mitochondrial single-nucleotide polymorphisms (mtSNPs) in a sample of 1238 individuals participating in the KORA (Cooperative Health Research in the Region of Augsburg) study. Participants were classified with 'no PTSD', 'partial PTSD' or 'full PTSD' by applying the Posttraumatic Diagnostic Scale and the Impact of Event Scale. To assess PTSD-mtSNP association while taking heteroplasmy into account, we used the raw signal intensity values measured on the microarray and applied linear regression. Significant associations were obtained between full versus no PTSD and two mtSNPs; mt8414CT (β=-0.954±0.06, Padjusted=0.037) located in adenosine triphosphate (ATP) synthase subunit 8 (MT-ATP8) and mt12501GA (β=-1.782±0.40, Padjusted=0.015) located in the NADH dehydrogenase subunits 5 (MT-ND5). Heteroplasmy for the two variants towards a larger number of the respective minor alleles increases the risk of having PTSD. NADH dehydrogenase and ATP synthase are both linked to the regulation of reactive oxygen species. Our results highlight the important role of the mitochondrial genome among the factors that contribute to the risk of PTSD. Mitochondrial genetic variants may be more important than has previously been assumed, leading to further insights regarding effects of existing medications, or even to the development of innovative treatments. As this is the first mitochondrial genome-wide association study for PTSDs, further analyses are needed to follow up on the present findings.

Objective: To assess whether alexithymia is a risk factor for exacerbation in spasmodic torticollis (ST). Methods: ST patients (2×10) with high vs. low alexithymia scores (mean score on the 20-item Toronto Alexithymia Scale [TAS-20]=69.2 vs. 28.7) were compared on physiological, motor and subjective responses to a cognitive and an emotional laboratory stressor. Changes in sustained abnormal head/shoulder positions and maximum range of motion (ROM) of the cervical spine were kinematically quantified. Skin conductance level (SCL), nonspecific skin conductance fluctuations (NS.SCF), heart rate (HR) and skin temperature (T) were measured. Results: High alexithymia had no effect on the abnormal head posture or movements, but high-alexithymic ST patients showed generally increased levels of autonomic arousal (more NS.SCF, higher SCL; analysis of variance [ANOVA]: P =.016 and P =.051, respectively) under all experimental conditions. When ST symptom severity (TSUI-score) was partialled out, these group differences were somewhat reduced (analysis of covariance [ANCOVA]: P =.052 and P =.143). Conclusions: High alexithymia did not lead to increased abnormal head movements to stressors, but may result in a subtle increase in tonic level of sympathetic activity.

Objectives A ssociations between well-being, serum levels of insulin-like growth factor 1 (IGF-I), and its primary binding protein IGFBP-3, were examined in an epidemiologic study. The influence of physical activity on the effect of hormones on well-being was considered. Methods Cross-sectional data from participants of the KORA-Age study (n=985, age 64–93) was analyzed in sex-specific multivariable regressions of well-being (World Health Organization (WHO) -5) or ill-being (geriatric depression scale (GDS) -15). Models were adjusted for age, physical activity, sleep, BMI, smoking, and cognition. Adjusted WHO-5 means demonstrated the interaction between hormone quintiles with physical activity. Results Full models indicated that increased IGFBP-3 positively associated with well-being in women (β estimate = 0.14, standard error (SE) = 0.06) and less so in men (β = 0.11, SE = 0.07). IGF-I associated positively with depression (β = 0.11, SE = 0.06) and negatively with well-being (β = − 0.11, SE = 0.06) in women. Similar but not statistically discernable effects were observed in men. Adjusted mean WHO-5 scores illustrated the positive effect of physical activity and IGFBP-3 on well-being in women only. Conclusions Opposite and independent associations of IGF-I and IGFBP-3 on well-being observed in women suggests neuroprotective effects of IGFBP-3 in age.

Patients who suffer from post-infarction depression are a high risk group with an increased mortality risk. The reasons for this are not known although it may be because such patients cannot cope with the chronic condition of cardiac disease. We designed a profile of clinical and behavioural outcome measurements representing recovery after myocardial infarction. 552 male survivors of acute myocardial infarction (29-65 years; mean = 53) were grouped at study entry according to their depression status. 377 patients were reassessed after 6 months and were divided into the following subgroups: 50 (13.3%) patients had severe depression; 85 (22.5%) moderate depression and 242 (64.2%) low degrees of depression in the initial study. There were no substantial differences in baseline characteristics between the index group and the drop-out group. The unadjusted relative risk for follow-up angina pectoris among patients with depression (severe versus low) was 3.12 (95% CI 1.58 to 6.16) and was 5.55 (CI 2.87 to 10.71) for emotional instability. The relative risk for maintenance of smoking habits was 2.63 (CI 1.23 to 5.60) and was for work resumption 0.39 (CI 0.18 to 0.88). There was no association between depression and the occurrence of late potentials. After adjustment for univariate variables (age, social class, recurrent infarction, helplessness) only small and nonsignificant changes in the relative risks were found. However the inverse association of depression and work resumption was lost after adjustment. The investigation revealed that persistent postinfarction depression is an independent and important source of subsequent morbidity and long-acting reduced quality of life. Depression has adverse effects on illness behaviour and pain perception.

While altered cortisol concentrations have been observed in subjects with type 2 diabetes their circadian cortisol profile is unknown.Using a cross-sectional design, we studied 63 ambulatory individuals with type 2 diabetes and 916 non-diabetic control subjects of the Cooperative Research in the Region of Augsburg (KORA)-F3 study. Circadian cortisol profiles were derived from saliva cortisol concentrations, determined on a regular weekday upon wake-up (F0), as well as ½ h (F½), 8 (F8) and 14 h (F14) after wake-up.Diabetic subjects exhibited a flattened circadian cortisol profile (rm-ANOVA: F[3,654]=3.41, p=0.02), with lower morning and higher afternoon and evening cortisol concentrations.We observed a flattened circadian cortisol rhythm in subjects with type 2 diabetes, providing evidence for a specific HPA system dysfunction.

Hintergrund. Das KORA-Age-Verbundprojekt hat zum Ziel, die Determinanten und Folgen von Multimorbidität im Alter zu ermitteln und nach Faktoren des erfolgreichen Alterns in der Allgemeinbevölkerung zu suchen. Material und Methoden. Die KORA-Age-Kohorte besteht aus 9197 Personen, die 1943 oder früher geboren wurden und Teilnehmer der KORA-Kohorte (KORA: Kooperative Gesundheitsforschung in der Region Augsburg) zwischen 1984 und 2001 waren. In der randomisierten Interventionsstudie KORINNA (Koronarinfarktnachbehandlung im Alter) wurde ein von Krankenschwestern durchgeführtes Case-Management-Programm mit 338 Herzinfarktpatienten getestet und gesundheitsökonomisch bewertet. Ergebnisse. In der KORA-Age-Kohorte wurden 2734 Todesfälle registriert, 4565 Personen nahmen an einer schriftlichen Befragung und 4127 Personen an einem Telefoninterview teil (Teilnahme: 76,2% bzw. 68,9%). Zusätzlich wurde eine alters- und geschlechtsstratifizierte Stichprobe von 1079 Personen untersucht (Teilnahme: 53,8%). Schlussfolgerung. Das KORA-Age-Verbundprojekt untersuchte eine große bevölkerungsbezogene Stichprobe älterer Menschen, die Aufschluss über die Verteilung und Determinanten von Multimorbidität und erfolgreichem Altern gibt.

Population-based epidemiological studies about the prevalence of chronic migraine using the 2004 International Headache Society (IHS) classification definition are rare. We analysed the data of the Deutsche Migräne und Kopfschmerz Gesellschaft headache study, which included 7417 adults in three regions of Germany, with respect to their headache. Additionally, body mass index, alcohol consumption and smoking behaviour were recorded. Using the IHS definition from 2004, chronic migraine was diagnosed in 0.2% of the population. Half of these patients also fulfilled the criteria of medication overuse headache (MOH). The distribution of migraine attacks per subject was highly skewed, with only 14% of all migraine patients having more than six migraine attacks per month. Patients with chronic migraine or MOH seem more often to be active smokers than controls without headache. A body mass index of ≥ 30 was present significantly more often in patients with MOH than in controls or in patients with episodic migraine. The skewed distribution of the numbers of attacks per patient supports the recommendation to differentiate between episodic migraine with low and high attack frequency, as is done in the classification of tension-type headache. It further suggests that migraine with high attack frequency might be biologically different. The higher prevalence of smokers and of patients with a body mass index ≥ 30 in chronic migraine or MOH supports the idea of a frontal dysfunction in these patients.

Objective: Biobehavioral mechanisms relating the Distressed (Type D) personality to cardiovascular disease are only beginning to be understood. Studies have suggested a number of biological mechanisms, but also behavioral mechanisms seem to play a role. The purpose of this review was to provide an overview of the current state of affairs onmechanisms that may explain the link between Type D personality and cardiovascular disease incidence and progression. Methods: A systematic search of the literature was performed in Pubmed and PsychInfo. Studies were selected that assessed biobehavioral mechanisms associated with Type D personality in healthy, at risk, or cardiovascular patient samples. Result: In heart failure patients, Type D personality has been related to autonomic dysfunction, increased levels of inflammation, increased anemia, renal dysfunction and elevated oxidative stress. In patients with acute coronary syndrome, cortisol levels were elevated. Type D personality was also associated with an increased risk of cardiac arrhythmia and acute myocardial stunning. Behavioral factors include poor adherence to treatment and poor health behaviours, including physical inactivity and smoking. However, these mechanisms may differ depending on age and the stage of the disease, as mortality effects of Type D also decline in older patients and in patients with severe heart disease i.e. heart failure. Conclusions: Type D seems to be associated with dysfunction of major biological regulatory systems as well as adverse health behaviours. Future studies should focus on the interrelations between biological and behavioral factors to elucidate their combined pathophysiological effects, and to guide the development of effective intervention strategies.

ObjectiveTo examine whether depression or social isolation or the combination of both is associated with high leptin levels.Research methods and proceduresIn this cross-sectional study, the study population comprised 1229 subjects. Social network was assessed according to the Social Network Index initially designed for the Alameda study. Depression was assessed using the DEEX scale. Four categories were built: “socially integrated, not depressed”, “socially integrated, depressed”, “socially isolated, not depressed”, “socially isolated, depressed”. Serum leptin concentrations were assessed.Logistic regression was performed in men and women separately to investigate the influence of the three different categories “socially integrated, depressed”, “socially isolated, not depressed” and “socially isolated, depressed” in comparison with the reference category “socially integrated, not depressed”. The probability belonging to the upper 30% of leptin values was modelled. Four models were adjusted for BMI, age, lifestyle factors, psychosomatic complaints and metabolic variables.ResultsIn men, but not in women a significant effect could be seen. The combination of depressed state and social isolation was associated with a four fold increased risk of belonging to the group with the 30% highest leptin levels in men, whereas in women odds ratios did not reach significance.DiscussionMen, who were socially isolated and depressed, had an increased risk for high leptin levels. Therefore the combination of social isolation and depression, which is known to be associated with the worst outcome in cardiovascular disease, may have the potential to increase leptin levels in men.