Role of Peripheral Vascular Resistance for the Association Between Major Depression and Cardiovascular Disease

Abstract

Abstract:Major depression and cardiovascular diseases are 2 of the most prevalent health problems in Western society, and an association between them is generally accepted. Although the specific mechanism behind this comorbidity remains to be elucidated, it is clear that it has a complex multifactorial character including a number of neuronal, humoral, immune, and circulatory pathways. Depression-associated cardiovascular abnormalities associate with cardiac dysfunctions and with changes in peripheral resistance. Although cardiac dysfunction in association with depression has been studied in detail, little attention was given to structural and functional changes in resistance arteries responsible for blood pressure control and tissue perfusion. This review discusses recent achievements in studies of depression-associated abnormalities in resistance arteries in humans and animal experimental models. The changes in arterial structure, contractile and relaxing functions associated with depression symptoms are discussed, and the role of these abnormalities for the pathology of major depression and cardiovascular diseases are suggested.

Chronic selective serotonin reuptake inhibition modulates endothelial dysfunction and oxidative state in rat chronic mild stress model of depression

“…We suggest that CMS-induced endothelial dysfunction contributes to changes in blood perfusion of vital organs which, in turn, can contribute to the pathology and comorbidity between major depression and cardiovascular diseases. In accordance with the hypothesis of an association between depression symptoms and small artery function (9), escitalopram treatment partially normalized the balance between the different pathways of endotheliumdependent relaxation. Changes in EDH-like and COX-2-dependent relaxation correlated with the responsiveness of rats to escitalopram treatment.…”

“…Furthermore, we have shown that the CMS susceptibility is also associated with reduced endothelium-dependent relaxation due to suppressed EDH-like pathway despite upregulation of the NO and cyclooxygenase 2 (COX-2)-dependent pathways in rat mesenteric resistance arteries (8). Importantly, these arteries are essential for the control of the blood pressure and tissue perfusion, but knowledge about their abnormalities in association with depression symptoms is limited (9). Since increased oxidative stress is common for both the endothelial dysfunction (67) and major depression disorder (46), we hypothesized that it might be one of the links between depression and cardiovascular diseases.…”

Vascular depression consensus report – a critical update

“…Depression and vascular disease are both common among the elderly, and cardiac dysfunction in association with depression is well documented [46, 61, 62]. These observations may provide clues about the mechanistic relationships, as depression-associated changes of peripheral vascular resistance are essential for the association of MDD with cardiovascular disease [63, 64]. …”

Depression and long-term prognostic outcomes following peripheral endovascular interventions in the VA Healthcare System

“…Hypertension has been identified as one of the established risk factors in PAD 15 and has also been identified as a potential mechanism for the association between depression and cardiovascular disease, including the coronary arteries, but potentially also for the peripheral arteries. 16 Stress and depression may trigger a cascade of hemodynamic changes, including higher sympathetic tone, increasing levels of noradrenaline, and increased vasoconstriction, as well as elevation in systemic arterial pressure. 16 Although hypertension is a modifiable risk factor, the treatment of hypertension in PAD is not as prominently targeted as one of the metrics that define high-quality PAD management, although one can argue that hypertension as a diagnosis warrants treatment in itself to manage cardiovascular risk.…”

“…16 Stress and depression may trigger a cascade of hemodynamic changes, including higher sympathetic tone, increasing levels of noradrenaline, and increased vasoconstriction, as well as elevation in systemic arterial pressure. 16 Although hypertension is a modifiable risk factor, the treatment of hypertension in PAD is not as prominently targeted as one of the metrics that define high-quality PAD management, although one can argue that hypertension as a diagnosis warrants treatment in itself to manage cardiovascular risk. 17…”