Depression Linked to Deadly Heart Disease By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  March 10, 2009--Exactly why depressed people are more likely to develop heart disease and die isn’t crystal clear. But more evidence suggests that severe depression does indeed raise the risk of deadly heart disease.

In a new report, investigators examined data from the Nurses’ Health Study, an ongoing large-scale trial that has been tracking the health of women since 1976. In this analysis, researchers included more than 63,000 individuals without a history of heart disease or stroke and categorized them as severely depressed, mildly depressed, or not depressed based upon responses to a standard mental health questionnaire. At the start of the trial in 1992, 7.9% of the women reported symptoms of severe depression, and all the women were followed for 12 years to track heart attacks and deaths from heart disease.

Researchers found that those who reported symptoms of severe depression were 50% more likely to experience a serious cardiovascular event during follow-up as compared to their non-depressed counterparts.  When adjusted for other risk factors for heart disease, this association became less pronounced.  In an interesting subset analysis the investigators further found that antidepressant medication use was associated with a 3-fold increased risk of sudden cardiac death.

However this last finding leads to more questions than answers.

“We suspect that antidepressant medication may well have been a marker for worse depression, not that antidepressant medications themselves were causing sudden cardiac death.” says lead study author William Whang, MD, MS, assistant professor of clinical medicine at Columbia University Medical Center in New York City.

The researchers also emphasize that their findings don’t mean that depression causes sudden cardiac death, but say the two are linked, and could possibly be explained by arrhythmia.  Depression may affect the body’s ability to control heart rhythm.

“The most relevant implication is that for women with depressive symptoms, management of coronary heart disease risk factors may be especially important because we know that reducing blood pressure, controlling cholesterol, and not smoking are things that can be done to reduce the risk of coronary heart disease events,” says Dr. Whang. “We found a higher risk of cardiac events, but mostly due to these coronary risk factors.”

In an accompanying editorial comment, Sanjiv M Narayan, MD, and Murray B. Stein, MD, MPH, of the University of California, San Diego say “prospective studies are necessary to resolve the controversy on whether antidepressant agents might directly cause coronary heart disease events and sudden cardiac arrest.”

This study and editorial comment are published in the March 17, 2009 issue of the Journal of the American College of Cardiology.

Sources:

Whang W et al. Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women. Results from the Nurses’ Health Study.  Journal of the American College of Cardiology, 2009.

Narayan SM and Stein MB. Editorial Comment: Do Depression or Antidepressants Increase Cardiovascular Mortality? The Absence of Proof Might be More Important than the Proof of Absence. Journal of the American College of Cardiology, 2009.

William Whang, MD, MS, Assistant Professor of Clinical Medicine, Columbia University Medical Center, New York, New York.