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• W2024494077 abstract "Byline: Krishnamachari. Srinivasan Research in recent decades suggests that depression and coronary heart disease (CHD) have a bidirectional relationship. Depression, independent of other risk factors in an otherwise healthy person, doubles the risk of developing CHD. [sup][1] Depression is seen in about 20% of the patients hospitalized with acute coronary syndromes either at admission or in the immediate period following recovery from CHD. [sup][2] Depression in Patients with Coronary Heart Disease Cross-sectional studies have reported that between 19 and 66% of the patients with myocardial infarction (MI) have depressive and anxiety symptoms, [sup][3],[4] and a significant proportion of these patients (17-44%) are diagnosed with major depression. [sup][5],[6],[7] In addition, major depression is also common following coronary bypass surgery [sup][8] and in patients with unstable angina. [sup][9] Thus, these studies suggest that the prevalence rate of depression among patients with CHD is far greater than the 12-month prevalence rate of 6.6% reported in the community. [sup][10] Impact of Depression on Pre-Existing Coronary Heart Disease Over the last two decades, evidence has accumulated for the adverse impact of depression in patients with CHD. In one of the earliest studies in this area, Frasure Smith et al. [sup][11] in their study of depression and coronary heart disease in 222 patients post MI, those diagnosed with major depression on a modified version of the Diagnostic Interview Schedule had an adjusted hazard ratio of 3.44 (95% CI 2.25-4.63) for mortality over 6 months of follow-up compared with the controls. This was approximately equivalent to the risk engendered by clinical factors such as diminished left ventricular function and past history of MI. In a subsequent study, the same group of investigators followed-up this cohort over 18 months. [sup][12] Although baseline depression still predicted mortality at 18 months, its impact mainly occurred in the first 6 months. Similar findings of high mortality in subjects with unstable angina and comorbid depression have been reported. [sup][9] In addition, depression also has a negative impact on survival rates following coronary artery bypass graft (CABG). Two studies reported that the presence of depression at baseline prior to CABG was an independent predictor of cardiovascular mortality post-CABG. [sup][13],[14] There is also a dose-response relationship between depression and death due to adverse cardiac events, [sup][15] with increased baseline depression scores being associated with a higher risk of cardiac mortality. [sup][16] Depression and the Risk of Development of Coronary Heart Disease Several prospective studies have reported depression as a risk factor for the development of CHD, and this risk is independent of other cardiovascular risk factors. In a large prospective community-based study, patients with a history of dysphoria or depression had 4.5-times relative risk (RR) of having an acute MI compared with non-depressed subjects independent of other cardiovascular risk factors. [sup][17] It was also noted in this study that the risk of developing CHD was linked to the severity of depression, with an RR of 4.5 for developing CHD in subjects with major depression as opposed to 2.1 for subjects with dysphoria. A metaanalysis of studies in this area reported an RR of 1.64 for the development of CHD in subjects with depression. [sup][1] Pathophysiological Link between Depression and Coronary Heart Disease Depression and lifestyle behavior There exist several possible mechanisms that underlie the relationship between depression and CHD. Depression is associated with unhealthy lifestyle; depressed patients have a sedentary lifestyle, more likely to smoke and consume alcohol and are overweight/obese. [sup][18],[19],[20] Depression is also associated with non-compliance to medical treatment. …" @default.
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• W2024494077 date "2011-01-01" @default.
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• W2024494077 title "Blues ain′t good for the heart" @default.
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