|
Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
April
13, 2009
Depression after Heart Disease Ups Risk of Heart Failure
Antidepressant therapy doesn’t appear to
lower risk, more research needed
Patients with heart disease who are subsequently diagnosed
with depression are at greater risk for heart failure (HF),
a condition in which the heart can’t pump enough blood
throughout the body, according to a new study published in
the April 21, 2009, issue of the Journal of the American
College of Cardiology. This study—the first to
investigate the influence of depression after heart disease
on the likelihood of developing HF—also found that taking
antidepressant medications to ease depressive symptoms did
not appear to mitigate this risk.
“Our data suggest that depression is an important and
emerging risk factor for heart failure among patients with
coronary heart disease,” said Heidi May, Ph.D., M.S.P.H.,
epidemiologist, Intermountain Medical Center, Murray, Utah.
“Interestingly, when we stratified patients with depression
by whether they received antidepressant medication or not,
the incidence of heart failure didn’t change. 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.”
Patients (n = 13,708) without a diagnosis of HF and depression
and who were not prescribed antidepressant medication at the
time of CAD diagnosis were studied. Of these, one out of 10
(n=1,377) was later diagnosed with depression.
Data reveal that a depression diagnosis following CAD was
associated with a 2-fold increased risk for the incidence
of HF (p < 0.0001). This risk remained, but was slightly
lower (HR: 1.50, 95% CI: 1.38 to 1.63, p < 0.0001) after
adjusting for other cardiovascular risk factors (e.g., diabetes,
hypertension, age). The incidence of HF among patients who
were not depressed after being diagnosed with coronary artery
disease (CAD) was 3.6 per 100 compared with 16.4 per 100 for
those with a post-CAD depression diagnosis. The increase in
the risk of a HF diagnosis was evident at the start of follow-up
for those with a diagnosis of depression post-CAD.
This prospective study represents an important area of inquiry
given the widespread burden of HF and depression, both of
which can severely limit daily functioning and contribute
to high rates of healthcare utilizations. Furthermore, previous
studies have shown that depression in patients with HF increases
the risk of hospitalization and death. Depression among heart
disease patients has also been found to be predictive of future
cardiovascular events, such as heart attack and even death.
For those with available medication records (n = 7,719),
patients subsequently diagnosed with depression were stratified
by use of antidepressant medications. No difference was found
between depressed patients using or not using antidepressants
(HR: 0.84, p = 0.24).
“Our findings indicate that it may be important for
clinicians to keep in mind that although a patient’s
depressive symptoms may improve, the risk for harmful cardiovascular
outcomes related to depression might not,” said May.
“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.”
There are a number of other risk factors associated with depression
and HF, including smoking, hypertension, diabetes and being
overweight. Prior studies have reported that patients with
depression are also less likely to practice good health habits
or adhere to treatment regimens (e.g., taking medications
properly, following a recommended exercise program and keeping
scheduled appointments).
Study participants were drawn from the cardiac catheterization
registry of the Intermountain Heart Collaborative Study and
used physician-diagnosed or ICD-9 codes to identify HF and
depression diagnoses. Patients were followed until HF diagnosis
or death. Average follow up was 5.6±3.6 years.
May added that future studies are needed to further explore
the association of depression and heart failure, as well as
other cardiovascular outcomes. She reports no conflict of
interest.
###
The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 36,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
the media, the public and other interested parties. However,
statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
of the ACC unless stated so.
|
