Depression Plus Heart Disease Linked to Higher Mortality

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People who suffer with both depression and heart disease are nearly five times more likely to die from any cause when compared with people who do not have this combination of conditions, according to a new study published in Heart. The risk of higher mortality in this population can serve to alert physicians to look for symptoms of depression in their heart patients.

Prior to this new study, researchers had often observed a relationship between depression and cardiovascular disease. For example, in a study published in August 2010 by researchers at Duke University, the authors noted that depression is particularly common among heart patients, and “there is growing evidence that depression is a risk factor for fatal and nonfatal events” in patients with coronary heart disease.

An earlier study published in the Archives of Internal Medicine evaluated the impact of enhanced depression treatment in patients with acute coronary syndrome. Investigators found that six months of depression care was associated with greater satisfaction, greater reduction in depressive symptoms, and a promising improvement in prognosis, including death.

Depression and Heart Disease: Mortality is 3 three times higher
Researchers collected data on 5,936 men and women who had participated in the British Whitehall II study. All had had their physical and mental health followed for 5.6 years. The analysis showed that approximately 14.9 percent had scored high on a depressive symptom scale. Twenty percent of patients with heart disease were depressed compared with 14 percent of those who did not have heart disease.

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After investigators took into account factors such as age and sex, they discovered that patients who had both heart disease and depression were three times more likely to die from all causes and four times more likely to die from a heart attack or stroke when compared with healthy individuals.

They also found that among participants who were depressed but otherwise healthy, their risk of dying from all causes was twofold compared with people who had neither depression nor heart disease.

Why depression has this effect on the risk of dying is not known, but experts have proposed it may stimulate inflammation (which has long been associated with a greater risk of heart disease), the formation of blood clots, changes in blood lipid metabolism and cellular response, as well as behavioral factors.

The authors concluded that their research shows “evidence that depressive symptoms are associated with an increased risk of all-cause and cardiovascular death,” and that this higher risk of mortality is especially evident in people who have both depression and heart disease.

SOURCES:
Davidson KW et al. Archives of Internal Medicine 2010 Apr 12; 170(7):600-8
Nabi H et al. Heart DOI: 10.1136/hrt.2010.198507
Wang JT et al. Expert Opin Pharmacother 2010 Aug 17

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