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Panel recommends listing depression as a risk factor for CVD
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Depression should join the list of recognized risk factors for CVD, along with others such as obesity, diabetes, hypertension and smoking, an expert panel recommended.
A 12-person panel of experts made this recommendation to the American Heart Association, based on published studies that found that depression increases the risk for MI or CV death.
"Although prospective studies, systematic reviews and meta-analyses have documented an association between depression and increased morbidity in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations," according to the statement published in Circulation.
The authors concluded that "the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome."
A call for formal recognition
The statement was created to review available evidence and make recommendations as to whether depression should be elevated to the status of a risk factor for patients with ACS.
Robert M. Carney
The panel evaluated 53 individual studies (32 reported on associations with all-cause mortality, 22 on composite outcomes, 12 on CV mortality) and four meta-analyses. "Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes," the panel wrote in the statement.
"The findings didn’t surprise us," panelist Robert M. Carney, PhD, professor of psychiatry at Washington University School of Medicine in St. Louis, said in a press release. "Many studies have reported that depression predicts increased mortality, but it’s rare to delve into this kind of research as deeply and as carefully as we have. Although we suspected we would find this link, having gone through all of these studies and conducted such a careful evaluation, we are more confident than ever that depression is a risk factor for mortality in people who have heart disease."
More research needed
Carney and panel member Kenneth E. Freedland, PhD, also from Washington University School of Medicine, have studied the effects of depression on CVD for more than 25 years. They first reported in 1988 that depression was associated with increased risk for cardiac events in patients with existing CVD.
Carney noted that when people lose weight, lower their BP or quit smoking, their risk for CVD is generally lowered. However, thus far, no studies have demonstrated that treating depression lowers cardiac risk.
"Unfortunately, very few studies have looked at that question," Carney said. "And, only one study has included enough subjects to determine whether treating depression could lower the risk of having a heart attack or dying from heart disease. Treatment did not lower the risk of heart attack or death, but that was the first study of its kind. More clinical trials are needed to identify treatments that may improve heart health along with depression."
Carney and Freedland are beginning a new clinical trial to evaluate whether a different approach to treatment can be more successful in alleviating depression and lowering the risk for future cardiac events.
"We believe better depression treatments may improve survival," Carney said. "More effective treatments certainly will improve a patient’s quality of life. More research will be needed, though, before we can say treating depression can improve heart health or survival in patients with heart disease."
What is known at this point, however, is that not treating depression can have negative effects on health and quality of life.
Disclosure: See the full study for the authors’ relevant financial disclosures.