Friday, 6 February 2015

Depression and risk of coronary heart disease

"The results of our meta-analysis suggest that depression is independently associated with a significantly increased risk of CHD [coronary heart disease] and MI [myocardial infarction], which may have implications for CHD etiological research and psychological medicine."
No owners means - no heartbreak!

So said the conclusion of the paper by Yong Gan and colleagues [1] (open-access) and their synthesis of the peer-reviewed literature on the topic of heart health and depression. Granted, such findings are probably not particularly great news to anyone with depression, but as per similar research on health and psychology discussed on this blog (see here), getting the message out is often an important first stage in doing something about mitigating any enhanced risk.

Glancing through some of the previous entries on this blog covering depression - in all its different forms - I realise that this is a topic which has already been raised in a previous entry (see here). In that case based on the study by Amit Shah and colleagues [2] the suggestion was that: "In adults younger than 40 years, depression and history of attempted suicide are significant independent predictors of premature CVD [cardiovascular disease] and IHD [ischemic heart disease] mortality in both sexes." Again, slightly sombre reading.

"Participants with depression, compared with those free of it, experienced a significant
increased risk of 30% for CHD and MI. Furthermore, the association remained significant in
the groups adjusted for potential confounders, such as lifestyle factors and socio-demographic
factors." An important summary from Gan and colleagues highlighting how, whilst their data did point to an increased risk of CHD and MI in relation to depression, one has to be slightly careful in how one communicates the words 'increased risk' and what a 30% risk might translate into in the real world.

Without exceeding the scope of this blog, and in particular my caveats about not giving anything that looks, sounds or smells like medical or clinical advice, I was interested in some discussion by Gan on the potential role of antidepressants to "reduce the risk of development of CHD." They suggested that it may not be as easy as such intervention just impacting on heart health as well as psychological health even though other studies have suggested some beneficial effect [3] to be had from certain antidepressants. I've talked before on this blog about depression and some of the slightly more alternative ways that have been put forward to manage symptoms as per the rise and rise of something like anti-inflammatory strategies for example (see here). If for example, one is to assume that exercise (also included in that post on potential strategies to manage depression) might also be a potentially important tool for at least some types of depression, might it also have some effect to mitigate risk of adverse heart conditions too?

Music to close. When footballers sing.... Glenn & Chris - Diamond Lights (in the 1980s).


[1] Gan Y. et al. Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry 2014, 14:371

[2] Shah AJ. et al. Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Archives of General Psychiatry. 2011: 68: 1135-1142.

[3] Pizzi C. et al. Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am J Cardiol. 2011 Apr 1;107(7):972-9.

---------- Gan Y, Gong Y, Tong X, Sun H, Cong Y, Dong X, Wang Y, Xu X, Yin X, Deng J, Li L, Cao S, & Lu Z (2014). Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC psychiatry, 14 (1) PMID: 25540022