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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
March
9, 2009
Feeling Down and Out Could Break Your Heart, Literally
Research links depression to cardiac death in
women without known heart disease
New data published in the March 17, 2009, issue of the Journal
of the American College of Cardiology suggest that relatively
healthy women with severe depression are at increased risk
of cardiac events, including sudden cardiac death (SCD) and
fatal coronary heart disease (CHD). Researchers found that
much of the relationship between depressive symptoms and cardiac
events was mediated by cardiovascular disease risk factors,
such as high blood pressure, high cholesterol and smoking.
“It’s important for women with depression to
be aware of the possible association between depression and
heart disease, and work with their health care providers to
manage their risk for coronary heart disease,” says
William Whang, M.D., M.S., Division of Cardiology, Columbia
University Medical Center, and lead investigator of the study.
“A significant part of the heightened risk for cardiac
events seems to be explained by the fact that coronary heart
disease risk factors such as high blood pressure, diabetes,
elevated cholesterol, and smoking were more common among women
with more severe depressive symptoms.”
Dr. Whang and his colleagues prospectively studied 63,469
women from the Nurses Health Study who had no evidence of
prior heart disease or stroke during follow-up between 1992
and 2004. Self-reported symptoms of depression and use of
antidepressant medication were used as measures of depression.
To best identify those with clinical depression, researchers
specifically examined women with the most severe symptoms
defined by a validated 5-point mental health index score of
less than 53 or regular antidepressant use.
The study found that women with more severe depressive symptoms
or those who reported taking antidepressants were at higher
risk for SCD and fatal CHD. In particular, women with clinical
depression were more than twice as likely to experience sudden
cardiac death. Surprisingly, this risk was associated more
strongly with antidepressant use than with depressive symptoms.
“These data indicate the link between depression and
serious heart rhythm problems may be more complex than previously
thought,” says Sanjiv M. Narayan, M.D., F.A.C.C., University
of California, San Diego, who co-authored the accompanying
editorial with colleague, Murray Stein, M.D. “It raises
the question of whether this association may have something
to do with the antidepressant drugs used to treat depression.”
Both Drs. Whang and Narayan stress that although the relationship
between antidepressant medicines and SCD merits further investigation
to determine whether antidepressant medications directly increase
the risk for heart rhythm disorders, at present the benefits
of appropriately prescribed antidepressants outweigh the risk
of sudden cardiac death. There was no relationship between
antidepressant use and fatal CHD or nonfatal heart attack.
“We can’t say antidepressant medications were
the cause of higher risk of sudden cardiac death. It may well
be that use of antidepressants is a marker for worse depression,”
adds Dr. Whang. “Our data raise more questions about
the mechanisms by which depression is associated with arrhythmia
and cardiac death.”
Plausible explanations for the link between depression and
SCD may include autonomic dysfunction, higher resting heart
rates and reduced heart rate variability, according to Dr.
Whang. Researchers also found an association with nonfatal
MI, but this became borderline non-significant when adjusted
for multiple other CHD risk factors.
Still, these study findings reinforce the need for patients
with depression to be monitored closely for risk factors for
coronary heart disease, since management of these risk factors
can reduce the risk for mortality from coronary heart disease
and sudden cardiac death.
Dr. Whang reports no conflict of interest.
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reports of clinical studies published in the Journal of
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