Monday, March 9, 2009
Depression linked to cardiac death
Healthy women with severe depression have double the risk of sudden cardiac death, as well as higher risk for fatal coronary heart disease.
Depression and heart disease are linked by cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol and smoking, which are more common among severely depressed women. Possible explanations could be autonomic dysfunction, higher resting heart rates and reduced heart rate variability.
Researchers prospectively studied 63,469 women from the Nurses Health Study with no evidence of prior heart disease or stroke between 1992 and 2004. They used self-reported symptoms of depression and antidepressant use, and then examined those with the most severe symptoms on a mental health index or those regularly using antidepressants. They reported their results in the Journal of the American College of Cardiology.
Low mental health index scores were associated with an increased risk of heart disease, with a hazard ratio of 1.5 after controlling for other risk factors. Sudden coronary death risk was 3.3 times greater in subjects who took antidepressants, more so than the mental health index scores, causing an editorial writer to raise the specter of needing further research into this drug class while emphasizing that the benefits outweigh the risk. As usual, one study raises more questions to answer. In the meantime, doctors should closely monitor patients with depression for risk factors for coronary heart disease.
Labels: cardiology, depression, heart, heart disease, heart failure
posted by Ryan DuBosar at
5:01 PM
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Monday, February 23, 2009
Temper, temper
The stereotypical image of the angry person suddenly clutching his or her chest might have found some physical evidence. Not just stress but strong emotions may lead to potentially lethal ventricular arrhythmias.
Researchers studied 62 patients with implantable cardioverter-defibrillators who underwent monitoring during a mental stress test that asked them to recall a recent situation in which they were angry.
Researchers measured the patients' T-wave alternans (TWA) and then followed them for a mean of 37 months to determine who had arrhythmias that triggered their pacemakers. Patients with higher levels of anger-induced TWA were more likely to trigger their pacemakers--a predictor of heightened risk of up to ten times that of other patients.
Combining exercise tests with mental stress test may help clinicians better select patients likely to have arrhythmia and benefit from a defibrillator, and it might provide insight for patients who can't exercise, researchers wrote in the Journal of the American College of Cardiology.
Naturally, therapies focused on helping patients deal with anger and other negative emotions may help reduce arrhythmias and, therefore, sudden cardiac death in certain patients. It's not the first time anger's been linked to heart disease, but researchers said we are beginning to understand how anger and other types of mental stress can trigger potentially lethal ventricular arrhythmias.
Labels: cardiology, heart, heart disease
posted by Ryan DuBosar at
5:01 PM
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Tuesday, November 25, 2008
How depression breaks the heart
It's been known for quite some time that depressed patients have a higher risk of heart problems than those who are mentally healthy. What's been unclear is why-- till now.
A new JAMA study finds that, in depressed patients with coronary heart disease, most of the higher risk of CV events can be chalked up to a lack of exercise.
The study followed more than 1,000 outpatients with CHD for nearly 5 years. Patients reporting symptoms of depression had a 50% greater risk of CV events. Adjusting for comorbid conditions and cardiac disease severity lowered the risk to 31%, but adjusting for lack of exercise pretty much wiped out the association completely (along with a few other "health behaviors," like diet). Put another way, not exercising was associated with a 44% higher rate of CV events-- almost the same as the depression association.
So now the real question is: how do you get those depressed patients to exercise? (Which, by the way, is likely to improve their mood.) That's a whole other study in and of itself. For now, the Mayo Clinic has these tips on motivating depressed patients.
Labels: cardiology, depression, heart, mental health
posted by Jessica Berthold at
4:00 PM
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