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Mechanisms linking depression to heart disease investigated
6 May 2008
MedWire News: Depression increases the risk for coronary heart disease (CHD) in patients without heart disease through autonomic dysregulation, inflammation, and endothelial dysfunction, say Italian researchers.
"Our findings are relevant from the pathophysiological viewpoint, but also possibly as a therapeutic target, since there are today several pharmacological, dietary, and lifestyle options to treat endothelial dysfunction and inflammation very early and effectively in the course of the disease," the authors write in the European Heart Journal.
Depression is known to increase the risk for cardiovascular events in both the general population and patients with CHD, but the underlying mechanisms remain unclear.
To study further, Maria Grazia Costa (Mario Negri Institute for Pharmacological Research, Bergamo) and colleagues enrolled 415 individuals without either CHD or diabetes but with at least two CHD risk factors, such as older age, male gender, current smoking, hypertension, or dyslipidemia.
Overall, 51.7% of the participants were males, aged 57.6 years on average, almost half were hypertensive, 43.9% were dyslipidemic, 30.4% were current smokers, and 23.1% had depressive symptoms (Beck Depression Inventory[BDI] score ≥10).
After adjustment for age, gender, and hypertension, patients with depression were significantly more likely than non-depressive individuals to be smokers, and to have higher levels of total cholesterol (odds ratio [OR]=1.27 for each 10 mg/dl increase), C-reactive protein levels ≥1.0 mg/dl (OR=5.83), and interleukin-6 levels ≥2.0 pg/ml (OR=1.89).
Depressed individuals were also more likely to have altered heart rate variability and their flow-mediated dilation was severely impaired (adjusted OR for 1% increase=0.72).
Costa and co-workers conclude: "Our data indicate an independent association between depression and impaired heart rate variability, systemic inflammation, and endothelial function.
"These mechanisms play a role not only in the complication of advanced forms of disease, but also promote and/or accelerate the early disease and connect depression and CHD."
