How does depression lead to cardiovascular adverse events?
Depression is recognized as a risk factor for the development of cardiovascular disease in healthy patients, for recurrent events in patients with established cardiovascular disease, and for adverse outcomes after coronary bypass graft surgery. Physical inactivity largely explains the association between depressive symptoms and adverse cardiovascular events such as heart failure, myocardial infarction, stroke, transient ischemic attack, or death.
Other possible explanatory factors for the association of depression with cardiovascular disease are:
- smoking
- lack of exercise
- medication non adherence
- worse underlying cardiac disease severity
- lower heart rate variability
- antidepressant toxicity
- enhanced activity of the hypothalamic pituitary axis
- greater catecholamine levels
- dietary factors,low omega-3fatty acid levels
- increased serotonin and platelet activation
- inflammatory processes
In a recent study published in a recent number of the JAMA this result was published. This publication is about a prospective cohort of 1017 participants with stable coronary disease. They evaluated the extent to which the association of depressive symptoms with subsequent cardiovascular events was explained by differences in comorbid conditions, cardiac disease severity, use of antidepressant medications, and potential biological and behavioral mediators.
Even when they adjusted for confounding factors, factors that could also mediate the influence on adverse cardiovascular events such as comorbid conditions and cardiac disease severity, depressive symptoms remained associated with a 31% increased rate of cardiovascular events.
However, no significant association between depressive symptoms and cardiovascular events remained after adjustment for physical activity and other health behaviors.
This means that it is possible that the increased risk of cardiovascular events associated with depression could potentially be preventable with behavior modification, especially exercise.
This important question whether exercise can decrease the excess risk of cardiovascular events associated with depressive symptoms has not been studied yet. It is possible that the combination of exercise and antidepressants can reduce the risk of cardiovascular events in patients with depression.
This study does not solve the direction of the relationship between physical activity and depression.
the association is almost certainly bidirectional because depression leads to physical inactivity, and physical inactivity exacerbates depression. This can result in a downward spiral in which depression and physical inactivity become mutually reinforcing.
Nevertheless inactivity appeared to account for almost half of the association between depressive symptoms and cardiovascular events in this study. This raises the possibility that increased exercise may decrease the risk of cardiovascular events associated with depression. What do you think?
M. A. Whooley, P. de Jonge, E. Vittinghoff, C. Otte, R. Moos, R. M. Carney, S. Ali, S. Dowray, B. Na, M. D. Feldman, N. B. Schiller, W. S. Browner (2008). Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease JAMA: The Journal of the American Medical Association, 300 (20), 2379-2388 DOI: 10.1001/jama.2008.711
aqua
January 19, 2009 @ 7:23 am
I’m sure exercise would help (if the depressed person could actually motivate themselves to exercise…I can’t seem to), but I have always wondered about how much internal stress…worry, anxiety, panic, negative thoughts etc. factor into an increased risk of heart problems.
I get so anxious sometimes (and quite often) that I can barely breathe and I feel like my heart is jumping around in my chest. With panic attacks I feel like I am having a heart attack sometimes because I get awful chest pains. It seems these types of behaviours might be risky to have. Constant worrying, anxiety, panic, insomnia…these can’t be good for anyone’s heart…or does it just FEEL like the pain is in the chest and heart?
…aqua
Dr Shock
January 19, 2009 @ 9:55 pm
Dear Aqua,
I remembered reading that they checked them with panic attacks for coronary artery troubles but couldn’t find these kind of lesions. Nevertheless, depression with or anxitey or panic can benefit from some exercise. You don’t have to run, some hikes or walks will do, kind regards Dr Shock
aqua
January 20, 2009 @ 1:43 am
Sometimes you remind me so much of my psychiatrist. (That’s a compliment) He has been trying to get me to swim, both for the exercise and because swimming is very meditative and calming for me. I know it would be good for me, but for some reason I haven’t been able to motivate myself yet. We set some goals last session and getting swimming once this week is on the list. I feel ready to try.
Dr Shock
January 20, 2009 @ 9:00 am
Try to make it fun time, ask a friend, I mostly run with a friend, pleasant company and a good laugh at times.
Ellen Kimball
January 23, 2009 @ 6:04 am
Hello! I really feel like you do, aqua, and even go to wonderful places with swimming pools. I’ve been a swimmer since I was three years old, but have been finding more and more reasons NOT to swim.
My doctor told me yesterday he wants me in the pool three days a week (no excuses). I see him again on March 3rd, and hope to have made some progress.
The following Saturday in March, we will be going to Nuevo Vallarta (Mexico), a resort near Puerto Vallarta. I think they have more than five pools.
Maybe I’m just a nutcase. I wish pleasure came easier to me than it does. Right now, I’ve got a big decision to make about changing medications. Not sure what to do.
Blessed be,
EK