Heartache and heartbreak—the link between depression and cardiovascular disease

• Published in: Nature reviews cardiology Vol. 9; no. 9; pp. 526 - 539
• Main Authors: Nemeroff, Charles B., Goldschmidt-Clermont, Pascal J.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2012; Nature Publishing Group
• Subjects: 692/699/476/1414; 692/699/75; Acute Disease; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - psychology; Complications and side effects; Depression - complications; Depression - epidemiology; Depression - psychology; Endothelium, Vascular; Epigenomics; Humans; Inflammation; Life Style; Major depressive disorder; Medicine; Medicine & Public Health; Oxidative Stress; review-article; Risk Factors; Stress, Psychological; United States - epidemiology; United States
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/nrcardio.2012.91

Depression increases the risk of cardiovascular disease and is a predictor of poor cardiovascular outcomes. The authors outline these epidemiological findings, describe the pathophysiological mechanisms that might underlie the risk of cardiovascular disease in patients with depression, and describe new data on the effects of successful treatment of depression on biological risk factors for coronary artery disease. The close, bidirectional relationship between depression and cardiovascular disease is well established. Major depression is associated with an increased risk of coronary artery disease and acute cardiovascular sequelae, such as myocardial infarction, congestive heart failure, and isolated systolic hypertension. Morbidity and mortality in patients with cardiovascular disease and depression are significantly higher than in patients with cardiovascular disease who are not depressed. Various pathophysiological mechanisms might underlie the risk of cardiovascular disease in patients with depression: increased inflammation; increased susceptibility to blood clotting (owing to alterations in multiple steps of the clotting cascade, including platelet activation and aggregation); oxidative stress; subclinical hypothyroidism; hyperactivity of the sympatho-adrenomedullary system and the hypothalamic–pituitary–adrenal axis; reductions in numbers of circulating endothelial progenitor cells and associated arterial repair processes; decreased heart rate variability; and the presence of genetic factors. Early identification of patients with depression who are at risk of cardiovascular disease, as well as prevention and appropriate treatment of cardiovascular disease in these patients, is an important and attainable goal. However, adequately powered studies are required to determine the optimal treatment regimen for patients with both depression and cardiovascular disorders. Key Points Depression is associated with increased risk of coronary artery disease, and increased morbidity and mortality after myocardial infarction, CABG surgery, congestive heart failure, or mitral valve replacement Depression-associated biological alterations include increased inflammation, a clotting diathesis, decreased variability in heart rate, increased activity of the sympathoadrenal and pituitary–adrenal axes, and a reduction in circulating endothelial progenitor cells Depression-associated biological alterations might mediate the link between depression and cardiovascular disease Results are inconclusive from studies designed to determine whether successful treatment of depression in patients with cardiovascular disease is associated with a reduction in subsequent major cardiac events Further research is required to determine whether normalization of these depression-associated biological alterations, resulting from effective treatment, contribute to a reduced risk of cardiovascular disease