***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE In a platelet/endothelial biomarker sub study of the Sertraline AntiDepressant Heart Attack R and omized Trial ( SADHART ) , the authors sought to determine whether plasma levels of sertraline and its primary metabolite N-desmethylsertraline affect the release of platelet/endothelial biomarkers . METHOD Fifty-five acute coronary syndrome patients with depression were r and omly assigned to receive sertraline ( N=23 ) or placebo ( N=32 ) . Twenty-six serial plasma sample s collected at week 6 ( N=12 ) and week 16 ( N=14 ) were analyzed . Platelet factor 4 ( PF4 ) , beta-thromboglobulin ( beta-TG ) , platelet/endothelial cell adhesion molecule 1 ( PECAM-1 ) , P-selectin , thromboxane B(2 ) ( TxB(2 ) ) , prostacyclin ( 6-keto-PGF1alpha ) , vascular cell adhesion molecule 1 ( VCAM-1 ) , and E-selectin were measured by enzyme-linked immunosorbent assay . Concentrations of sertraline and N-desmethylsertraline were determined by liquid chromatography with fluorescence detection in autologous sample s. RESULTS Strong , mostly time-dependent negative correlations were found for the plasma levels of sertraline and N-desmethylsertraline with PF4 ( week 6 : r=-0.69 and -0.33 , respectively ; week 16 : r=-0.63 for both ) , beta-TG ( week 6 : r=-0.43 and -0.29 ; week 16 : r=-0.66 and -0.57 ) , PECAM-1 ( week 6 : r=-0.82 and -0.49 ; week 16 : r=-0.60 for both ) , P-selectin ( week 6 : r=-0.82 and -0.49 ; week 16 : r=-0.73 and -0.43 ) , and TxB(2 ) ( week 6 : r=-0.66 and -0.59 ; and week 16 : r=-0.64 and -0.41 ) . Regression analysis revealed some borderline correlations for endothelial markers such as 6-keto- PGF1alpha and E-selectin and a positive correlation for VCAM-1 . CONCLUSIONS This is the first documented evidence that plasma release of platelet/endothelial biomarkers is directly related to the levels of sertraline and N-desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression . The clinical significance of these findings should be assessed in the setting of a r and omized clinical trial CONTEXT Depression and low perceived social support ( LPSS ) after myocardial infa rct ion ( MI ) are associated with higher morbidity and mortality , but little is known about whether this excess risk can be reduced through treatment . OBJECTIVE To determine whether mortality and recurrent infa rct ion are reduced by treatment of depression and LPSS with cognitive behavior therapy ( CBT ) , supplemented with a selective serotonin reuptake inhibitor ( SSRI ) antidepressant when indicated , in patients enrolled within 28 days after MI . DESIGN , SETTING , AND PATIENTS R and omized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients ( 1084 women , 1397 men ) enrolled from 8 clinical centers . Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression ( HRSD ) ; LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients ( ENRICHD ) Social Support Instrument ( ESSI ) . R and om allocation was to usual medical care or CBT-based psychosocial intervention . INTERVENTION Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months , plus group therapy when feasible , with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50 % reduction in Beck Depression Inventory scores after 5 weeks . MAIN OUTCOME MEASURES Composite primary end point of death or recurrent MI ; secondary outcomes included change in HRSD ( for depression ) or ESSI scores ( for LPSS ) at 6 months . RESULTS Improvement in psychosocial outcomes at 6 months favored treatment : mean ( SD ) change in HRSD score , -10.1 ( 7.8 ) in the depression and psychosocial intervention group vs -8.4 ( 7.7 ) in the depression and usual care group ( P<.001 ) ; mean ( SD ) change in ESSI score , 5.1 ( 5.9 ) in the LPSS and psychosocial intervention group vs 3.4 ( 6.0 ) in the LPSS and usual care group ( P<.001 ) . After an average follow-up of 29 months , there was no significant difference in event-free survival between usual care ( 75.9 % ) and psychosocial intervention ( 75.8 % ) . There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups ( depression , LPSS , and depression and LPSS patients ) . CONCLUSIONS The intervention did not increase event-free survival . The intervention improved depression and social isolation , although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients CONTEXT Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease , but the mechanisms responsible for this association are unknown . OBJECTIVE To determine why depressive symptoms are associated with an increased risk of cardiovascular events . DESIGN AND PARTICIPANTS The Heart and Soul Study is a prospect i ve cohort study of 1017 out patients with stable coronary heart disease followed up for a mean ( SD ) of 4.8 ( 1.4 ) years . SETTING Participants were recruited between September 11 , 2000 , and December 20 , 2002 , from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12 , 2008 . MAIN OUTCOME MEASURES Baseline depressive symptoms were assessed using the Patient Health Question naire ( PHQ ) . We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events ( heart failure , myocardial infa rct ion , stroke , transient ischemic attack , or death ) was explained by baseline disease severity and potential biological or behavioral mediators . RESULTS A total of 341 cardiovascular events occurred during 4876 person-years of follow-up . The age-adjusted annual rate of cardiovascular events was 10.0 % among the 199 participants with depressive symptoms ( PHQ score > or = 10 ) and 6.7 % among the 818 participants without depressive symptoms ( hazard ratio [ HR ] , 1.50 ; 95 % confidence interval , [ CI ] , 1.16 - 1.95 ; P = .002 ) . After adjustment for comorbid conditions and disease severity , depressive symptoms were associated with a 31 % higher rate of cardiovascular events ( HR , 1.31 ; 95 % CI , 1.00 - 1.71 ; P = .04 ) . Additional adjustment for potential biological mediators attenuated this association ( HR , 1.24 ; 95 % CI , 0.94 - 1.63 ; P = .12 ) . After further adjustment for potential behavioral mediators , including physical inactivity , there was no significant association ( HR , 1.05 ; 95 % CI , 0.79 - 1.40 ; P = .75 ) . CONCLUSION In this sample of out patients with coronary heart disease , the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors , particularly physical inactivity CONTEXT There has been little research on the treatment of depression after coronary artery bypass surgery . OBJECTIVE To test the efficacy of 2 nonpharmacological interventions for depression after  coronary artery bypass surgery  compared with usual care . DESIGN A 12-week , r and omized , single-blind clinical trial with outcome evaluations at 3 , 6 , and 9 months . SETTING Outpatient research clinic at Washington University School of Medicine , St Louis , Missouri . PATIENTS One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery . INTERVENTION Twelve weeks of cognitive behavior therapy or supportive stress management .  Approximately half of the participants were taking non study antidepressant medications .  MAIN OUTCOME MEASURE Remission of depression , defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression . RESULTS Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy ( 71 % ) and supportive stress-management ( 57 % ) arms than in the usual care group ( 33 % ) ( chi(2)(2 ) = 12.22 , P = .002 ) . Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy ( mean [ st and ard error ] , 5.5 [ 1.0 ] ) and the supportive stress-management ( 7.8 [ 1.0 ] ) arms than in the usual care arm ( 10.7 [ 1.0 ] ) at 3 months . The differences narrowed at 6 months , but the remission rates differed again at 9 months ( 73 % , 57 % , and 35 % , respectively ; chi(2)(2 ) = 12.02 , P = .003 ) . Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression , anxiety , hopelessness , stress , and quality of life . Supportive stress management was superior to usual care only on some of the measures . CONCLUSIONS Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery , relative to usual care . Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00042198 Background —Depression after acute coronary syndromes ( ACSs ) has been identified as an independent risk factor for subsequent cardiac death . Enhanced platelet activation has been hypothesized to represent 1 of the mechanisms underlying this association . Selective serotonin reuptake inhibitors ( SSRIs ) are known to inhibit platelet activity . Whether treatment of depressed post-ACS patients with SSRIs alters platelet function was not known . Accordingly , we serially assessed the release of established platelet/endothelial biomarkers in patients treated with sertraline vs placebo in the Sertraline AntiDepressant Heart Attack R and omized Trial ( SADHART ) . Methods and Results —Plasma sample s ( baseline , week 6 , and week 16 ) were collected from patients r and omized to sertraline ( n=28 ) or placebo ( n=36 ) .  Anticoagulants , aspirin , and ADP-receptor inhibitors were permitted in this study . Platelet factor 4 , & bgr;-thromboglobulin ( & bgr;TG ) , platelet/endothelial cell adhesion molecule-1 , P-selectin , thromboxane B2 , 6-ketoprostagl and in F1a , vascular cell adhesion molecule-1 , and E-selectin were measured by ELISA . Treatment with sertraline was associated with substantially less release of platelet/endothelial biomarkers than was treatment with placebo . These differences attained statistical significance for & bgr;TG ( P = 0.03 ) at weeks 6 and 16 and for P-selectin ( P = 0.04 ) at week 16 . Repeated- measures ANOVA revealed a significant advantage for sertraline vs placebo for diminishing E-selectin and & bgr;TG concentrations across the entire treatment period . Conclusions —Treatment with sertraline in depressed post-ACS patients is associated with reductions in platelet/endothelial activation despite coadministration of widespread antiplatelet regimens including aspirin and clopidogrel . The antiplatelet and endothelium-protective properties of SSRIs might represent an attractive additional advantage in patients with depression and comorbid coronary artery and /or cerebrovascular disease This study investigated the effects of antidepressant treatment on platelet activation in depressed patients with ischemic heart disease ( IHD ) . Plasma levels of platelet alpha-granule release products beta-thromboglobulin ( BTG ) and platelet factor 4 ( PF4 ) were measured in 17 depressed patients with IHD who were treated in a 6-week , double-blind trial with either paroxetine ( 10 patients ) or nortriptyline ( 7 patients ) . Baseline measurements of BTG and PF4 were significantly elevated in both drug treatment groups before the initiation of antidepressant therapy compared with those of healthy control subjects . In the paroxetine group , mean PF4 and BTG levels significantly decreased from these elevated baseline values within 1 week of treatment and remained low at 3- and 6- 
    Output:
    
Based on one trial per outcome , no beneficial effects on mortality rates , cardiac events , cardiovascular hospitalizations and QoL were found , except for the psychosocial dimension of QoL. Furthermore , no differences on treatment outcomes were found between the varying psychological approaches .
Psychological interventions and pharmacological interventions with SSRIs may have a small yet clinical ly meaningful effect on depression outcomes in CAD patients .
No beneficial effects on the reduction of mortality rates and cardiac events were found .