Depression Raises Heart Failure Risk In Heart Disease Patients

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Main Category: Heart Disease
Also Included In: Depression;  Mental Health;  Cardiovascular / Cardiology
Article Date: 14 Apr 2009 - 2:00 PST

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A new US study found that patients with heart disease who were then diagnosed with depression were at greater risk of heart failure, and that taking antidepressants neither reduced the risk of heart failure, a condition where the heart can't pump enough blood for the body, nor eased the symptoms of depression.

The study was the work of researchers based at the Intermountain Medical Center, Murray, and the University of Utah, Salt Lake City, both in Utah, and is published in the April 21 issue of the Journal of the American College of Cardiology, altthough it is already available online.

First author Dr Heidi May, an epidemiologist at the Intermountain Medical Center, told the press that:

"Our data suggest that depression is an important and emerging risk factor for heart failure among patients with coronary heart disease."

She said it was interesting that they found no difference in heart failure incidence between patients on antidepressants and those who were not.

"This finding may indicate that antidepressants may not be able to alter the physical or behavioral risks associated with depression and heart failure, despite a potential improvement in depressive symptoms," she suggested.

May and colleagues studied 13,708 coronary artery disease (CAD) patients who did not have a diagnosis of heart failure and depression and who were not being prescribed antidepressants at the time their CAD was diagnosed. 1,377 of these patients were later diagnosed with depression.

The patients came from the cardiac catheterization registry of the Intermountain Heart Collaborative Study and the average follow up was 5.6 years.

The results showed that:

• A diagnosis of depression after CAD was signficantly linked to a 2-fold higher risk of heart failure (p<0.0001).


• The risk lowered slightly (to 1.5) when other cardiovascular risk factors were taken into account (eg diabetes, blood pressure, age).


• The incidence of heart failure among patients without depression after receiving a CAD diagnosis was 3.6 per 100.


• This compared with 16.4 per 100 for those who were diagnosed with depression following a CAD diagnosis.


• For CAD-diagnosed patients who were then diagnosed with depression, the higher risk of heart failure was evident at the start of the follow up period.


• For the 7,719 whose medication records were available, there was no difference in heart failure risk between depressed patients using and not using antidepressants.

May and colleagues concluded that depression diagnosis was shown to be associated with an increased incidence of heart failure after CAD diagnosis, regardless of whether patients were receiving antidepressants or not.

"This finding suggests the need to further study the effect of depression on HF [heart failure] risk among CAD patients," they added.

May said the findings show it could be important for doctors to bear in mind that although the patient may feel less depressed as a result of antipressant medication, the risk of harmful cardiovascular outcomes may still be high.

"Patients need to be carefully screened for depression so that interventions that alter some of the risk associated with depression can be used and the related risk of heart failure and other cardiovascular events can be diminished," she added.

There are a number of other risks linked to depression and heart failure, such as smoking, high blood pressure, diabetes, and being overweight, and research also shows that people who are depressed are less likely to be eating healthily, taking exercise, keeping appointments or taking their medication properly, according to information from the American College of Cardiology.

"Depression After Coronary Artery Disease Is Associated With Heart Failure."
May, Heidi T, Horne, Benjamin D, Carlquist, John F, Sheng, Xiaoming, Joy, Elizabeth, Catinella, A Peter.
J Am Coll Cardiol 2009 53: 1440- 1447.
doi:10.1016/j.jacc.2009.01.036

Sources: American College of Cardiology.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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