Depression and coronary heart disease: mechanisms, interventions, and treatments

Abstract

Coronary heart disease (CHD), a cardiovascular condition that poses a significant threat to human health and life, has imposed a substantial economic burden on the world. However, in contrast to conventional risk factors, depression emerges as a novel and independent risk factor for CHD. This condition impacts the onset and progression of CHD and elevates the risk of adverse cardiovascular prognostic events in those already affected by CHD. As a result, depression has garnered increasing global attention. Despite this growing awareness, the specific mechanisms through which depression contributes to the development of CHD remain unclear. Existing research suggests that depression primarily influences the inflammatory response, Hypothalamic-pituitary-adrenocortical axis (HPA) and Autonomic Nervous System (ANS) dysfunction, platelet activation, endothelial dysfunction, lipid metabolism disorders, and genetics, all of which play pivotal roles in CHD development. Furthermore, the effectiveness and safety of antidepressant treatment in CHD patients with comorbid depression and its potential impact on the prognosis of CHD patients have become subjects of controversy. Further investigation is warranted to address these unresolved questions.

Impaired Modulation of the Autonomic Nervous System in Adult Patients with Major Depressive Disorder

“…A hyperfunction of the HPA axis can also alter cardiac autonomic function with sympathetic overactivation and parasympathetic hypofunction. This imbalance of the cardiac autonomic function may result in an increased heart rate, an increased myocardial contractility, and an increased myocardial oxygen consumption, which finally makes the heart more susceptible to malignant cardiac arrhythmias [ 11 , 27 ].…”

“…The aim of this study was to compare the responses of the ANS in patients with MDD to challenges that stimulated the sympathetic and, respectively, the parasympathetic nervous systems. Due to the bidirectional relationship between MDD and CHD, given that MDD is a relevant risk factor for CHD and that patients with CHD and MDD often showed a more pronounced affection for the ANS than CHD patients without MDD [ 9 , 11 ], we focused on patients with MDD without known CHD.…”

Type D Personality and Psychological Distress: A Correlational Study among Coronary Heart Disease Patients

“…The studies conducted by Xu et al (2024) and Lin et al (2017) revealed the positive relationship between type D personality and increased depressive and anxiety symptoms among heart patients. In accordance with traditional risk factors, psychological factors have been shown as predictors of harmful heart disease outcomes.…”