Heartache and heartbreak—the link between depression and cardiovascular disease

Abstract

The close, bidirectional relationship between depression and cardiovascular disease is well established. Major depression is associated with an increased risk of coronary artery disease and acute cardiovascular sequelae, such as myocardial infarction, congestive heart failure, and isolated systolic hypertension. Morbidity and mortality in patients with cardiovascular disease and depression are significantly higher than in patients with cardiovascular disease who are not depressed. Various pathophysiological mechanisms might underlie the risk of cardiovascular disease in patients with depression: increased inflammation; increased susceptibility to blood clotting (owing to alterations in multiple steps of the clotting cascade, including platelet activation and aggregation); oxidative stress; subclinical hypothyroidism; hyperactivity of the sympatho-adrenomedullary system and the hypothalamic-pituitary-adrenal axis; reductions in numbers of circulating endothelial progenitor cells and associated arterial repair processes; decreased heart rate variability; and the presence of genetic factors. Early identification of patients with depression who are at risk of cardiovascular disease, as well as prevention and appropriate treatment of cardiovascular disease in these patients, is an important and attainable goal. However, adequately powered studies are required to determine the optimal treatment regimen for patients with both depression and cardiovascular disorders.

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

“…SES and psychosocial factors, including depressive symptoms, psychological distress, and perceived stress, have been increasingly recognized as risk factors for CVD 3, 4, 7. Only recently have researchers begun to appreciate the information to be learned by considering both sets of factors simultaneously to better identify persons at elevated risk of poor cardiovascular outcomes and mortality 21, 23, 24, 25, 41.…”

“…Substantial evidence, however, has demonstrated that psychosocial factors also contribute to the development of CVD 3. In particular, depression4, 5, 6 and perceived psychosocial stress7, 8, 9 have been linked to increased CVD risk, and some research has demonstrated that the confluence of these 2 factors may be particularly deleterious for cardiovascular health 10, 11, 12. This latter finding is consistent with a recently proposed psychosocial “perfect storm13” model 13 of CVD risk that suggests an underlying vulnerability (eg, depression) is associated with greater risk of cardiac events and mortality, particularly in the presence of perceived stress.…”

“…This latter finding is consistent with a recently proposed psychosocial “perfect storm13” model 13 of CVD risk that suggests an underlying vulnerability (eg, depression) is associated with greater risk of cardiac events and mortality, particularly in the presence of perceived stress. Although examinations of the association between depressive symptoms or stress and CVD are increasingly common,4, 6, 7, 8, 9, 14, 15, 16, 17, 18, 19 fewer studies have examined the combined effects of depressive symptoms and stress 10, 11. The perfect storm model emphasizes the importance of considering the convergence of a variety of factors that contribute to CVD risk rather than focusing on 1 risk factor in isolation.…”

Do Psychiatric Comorbidities Influence Inpatient Death, Adverse Events, and Discharge After Lower Extremity Fractures?

“…The impact of psychiatric comorbidity on illness, treatment outcomes, and use of healthcare resources has been studied in great detail in certain fields of medicine, predominantly cardiology and neurology [10,17,28,34]. Depression has been linked to an increased mortality rate after myocardial infarction, cerebrovascular disease, and cancer [32].…”

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…Ageing (which increases the odds of both conditions), lifestyle factors, inflammation pathways, heart rate variability, impaired arterial repair and several genes, are just some of the mechanisms that could play a role. 14 Nevertheless, the link is well established. A review by the American Heart Association 15 recently recommended that depression be considered an independent risk factor for adverse outcomes in patients with acute coronary syndrome, given the strength of the evidence in the current literature.…”