Depression associated with poor outcomes in coronary heart disease patients
According to a recent study published in the Nov. 26 issue of the Journal of the American Medical Association, depression may be associated with worse outcomes in patients with coronary heart disease. According to the study, the correlation between worse outcomes and depression in coronary heart disease patients may be due to the fact that depression lessens healthy behaviors. For instance, a depressed patient may not take their medications or may not get enough exercise. Mary A. Whooley, M.D., of the University of California San Francisco, and colleagues, reported that cardiac patients with depressive symptoms had a 31% higher rate of cardiovascular events. The following is an excerpt of an article from Medpage Today that reviews the study:
Earlier studies had suggested biological factors like norepinephrine, inflammation, and cortisol could be responsible, but these captured surprisingly little of the effect in their prospective cohort study, Dr. Whooley said.
Rather, adjustment for health behaviors such as physical inactivity and medication adherence eliminated the link (P=0.75).
This is good news for physicians and patients Dr. Whooley said.
“Exercise training can improve both depressive symptoms and markers of cardiovascular risk,” they wrote.
The downside, though, is that lasting changes in behavior, particularly with regard to exercise, are difficult, Dr. Wholley added.
But even for patients who are able to achieve improvements, it’s not been proven that the cardiovascular risk associated with depression would disappear, Dr. Whooley said.
Given the benefits of physical activity across the board, though, she said physicians should still find ways to motivate their patients to make these changes.
Dr. Whooley and her colleagues conducted the prospective Heart and Soul Study among 1,017 patients seen for stable coronary disease at 12 outpatient clinics in the San Francisco area.