Article

Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease

VA Medical Center, San Francisco, California, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2008; 300(20):2379-88. DOI: 10.1001/jama.2008.711
Source: PubMed

ABSTRACT

Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown.
To determine why depressive symptoms are associated with an increased risk of cardiovascular events.
The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years.
Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008.
Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators.
A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score > or = 10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16-1.95; P = .002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00-1.71; P = .04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94-1.63; P = .12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79-1.40; P = .75).
In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.

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    • "Low socioeconomic level, lack of social support, presence of stressful familial and professional conditions contribute both to the risk for CAD development and deterioration of the clinical course of CAD[19]. Perception of social support by the individual has been reported to eliminate the unfavorable effects of depression[17]while lack of support enhances the unfavorable effects[20]. Depression and anxiety are psychological variables which influence morbidity and mortality in CAD and VHD.202203204205206207208209ever, there are no studies in the literature investigating whether depression and anxiety differ between these two diseases. "

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    • "Depression likewise worsens prognosis in patients with CAD. In a 5-year longitudinal study on 1,000 cardiac patients, Whooley and colleagues found that depressive symptoms at the baseline were associated with adverse events over the followup through behavioural factors namely physical inactivity (Whooley et al., 2008). Here, depression-related lethargy decisively influenced physical well-being. "
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