Cardiac disease linked to depression

There are a number of issues that are considered risk factors for cardiac disease, that is, they increase the risk that someone may develop a heart attack. Some can be controlled or modified, others cannot.

Since cardiac disease is the number one cause of mortality in the US, it’s important to look at these factors and work to decrease or modify those that can increase the threat of cardiovascular disease.

In the past, all of those risk factors have been physical ones (age, hypertension, smoking and others). A growing body of evidence indicates that there may be at least one psychological factor to add to the equation: Depression.

There are some risk factors that cannot be modified. Givens such as genetics, age and gender are unalterable.

For example, some families have a history of developing heart disease that starts early. There may be family members who have heart attacks in their early 40s, 30s or even in their 20s.

Aging increases the risk for having a heart attack. Older people thus have a higher risk of cardiovascular disease.

Men are at risk to have heart attacks earlier than women. But risk in women begins to approximate that of men after women finish menopause.

There is not much that we can do about those listed above. However, we can focus on factors that can be controlled or modified to lower risk.

Modifiable risks of cardiac disease, including depression

Modifiable risk factors include things like: hypertension, diabetes, smoking, elevated blood lipids, obesity, lack of exercise and others. These things can be altered to help lower the chance of a cardiovascular event.

Diabetes can be controlled. Patients can stop smoking. Blood pressure can be managed. Blood lipids can be lowered. Additionally, other factors that may play a role can also be modified. Patients can eat a more healthful diet, lose weight, begin to exercise regularly and do other things to develop a more healthy lifestyle.

Broken heart by Shutterstock

Broken heart by Shutterstock

For decades, the American Heart Association (AHA) has sponsored research into and published information about cardiovascular diseases. They’ve compiled a list of some of the things that may lead to a heart attack. In a recent study, they looked at the possibility that there might be a psychological risk factor that could lead to heart attacks. That factor is depression.

There was some previous research that showed an increase in heart disease in patients who had concurrent depression. Some studies, dating back over 20 years, showed that some psychological factors could elevate the risk for a heart attack and/or increase the chance for a poorer outcome after someone had a heart attack.

The AHA convened a panel of experts in the field to review a large number of studies that looked at the role of depression in cardiovascular diseases. The panel reviewed a number of studies. Some had only 100+ research subjects, but others included studies that contained over 10,000 patients. Some of these patient populations were followed for years to see whether or not they developed cardiovascular diseases. The research was done in Europe, Asia and the US.

Essentially, what these, and some of the other studies showed, was that depression is correlated with the risk of having a heart attack. People who have a heart attack and are depressed have worse outcomes than patients who have heart attacks and are not depressed.

The recommendation of the committee is that the AHA include depression as a risk factor for cardiovascular disease.

In addition to the previously cited physical risk factors (blood lipids, hypertension, etc.) we also need to look at the psychological factors that may contribute, as well.

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Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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