What is the role of depression in patients with cardiovascular disease?
What is the role of depression in patients with cardiovascular disease?
Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression.
Studies have shown that mental stress has a negative effect on a person’s heart health. In particular:
- Unmanaged stress can lead to high blood pressure, arterial damage, irregular heart rhythms and a weakened immune system.
- Patients with depression have been shown to have increased platelet reactivity, decreased heart variability and increased proinflammatory markers (such as C-reactive protein or CRP), which are all risk factors for cardiovascular disease.
- For people with heart disease, depression can increase the risk of an adverse cardiac event such as a heart attack or blood clots. For people who do not have heart disease, depression can also increase the risk of a heart attack and development of coronary artery disease.
- In one landmark study, the continued presence of depression after recovery increased the risk of death (mortality) to 17 percent within 6 months after a heart attack (versus 3 percent mortality in heart attack patients who didn’t have depression).
- During recovery from cardiac surgery, depression can intensify pain, worsen fatigue and sluggishness, or cause a person to withdraw into social isolation. Patients who have had CABG and have untreated depression after surgery also have increased morbidity and mortality.
- Patients with heart failure and depression have an increased risk of being readmitted to the hospital, and also have an increased mortality risk.
- Early research findings have indicated there may be genetic factors that increase a patient’s risk of depression and risk of recurrent cardiac events after a heart attack.
- Patients with heart disease and depression also perceive a poorer health status, as manifested by Quality of Life (QoL) studies. Furthermore, heart disease patients with depression have worse treadmill exercise and medication adherence than that of patients with heart disease who do not have depression.
- Negative lifestyle habits associated with depression – such as smoking, excessive alcohol consumption, lack of exercise, poor diet and lack of social support – interfere with the treatment for heart disease.
- Depression has been proven to be a such a risk factor in cardiac disease that the American Heart Association (AHA) has recommended that all cardiac patients be screened for depression using simple screening questions and an easy-to-administer survey called the Patient Health Questionnaire (PHQ-2).