Frontiers | Depression and the Link with Cardiovascular Disease | Psychiatry
The search terms “depression, major depressive disorder, coronary heart disease and up to 65% of women measured as having depression on the hospital anxiety . The underlying mechanism linking MDD and CHD are complex and multifactorial. .. Depression and cardiovascular disease: healing the broken-hearted. Stress, Anxiety, Depression and Heart Failure. “There is a two-way relationship between heart disease and depression,” Gebska says. Gebska says it is somewhat difficult to prove that heart disease directly leads to a patient's Women younger than age 55 who have both depression and premature coronary artery. Depression and Cardiovascular Disease; How Depression Can Promote of a clear relationship between mental health and cardiovascular diseases, patients with coronary disease, myocardial infarction, heart failure, and including those due to stress, makes it very difficult for physicians and their.
Better understanding of the common causal pathways will help us delineate more appropriate treatments. Abstracts were then hand screened for relevance and were selected on the basis of addressing mechanisms associating MDD and CHD.
Depression and Coronary Heart Disease Prevalence Major depression is a debilitating condition that presents with a number of cognitive and biological symptoms, including a pervasively lowered mood, anhedonia, negative cognitions, anergia, and appetite disturbance, and at its worst can manifest itself with suicidal thoughts and acts and psychotic features 1.
The leading cause of mortality in the developed world is coronary artery disease CAD. When cardiac disease and major depression present together, the prognosis for both worsen 10 — Reviews have continually shown that major depression is associated with poorer quality of life 13 and increased morbidity 14 — 16 and mortality 7 — 917 A meta-analysis of 11 studies showed that MDD conferred an overall relative risk of 1.
The severity of the depression is proportional to the risk of developing CAD Regarding mortality, MDD confers a relative risk of 1. For those who have suffered a MI, the presence of MDD is a bad prognostic factor and carries a five times increased risk of cardiac mortality within 6 months Mechanisms of Major Depression and Increased Cardiac Risk It has long been accepted that there are numerous behavioral and lifestyle factors at play that confers increased CHD risk in those suffering depression.
This in turn has a number of deleterious downstream effects, including the development of hypertension, left ventricular hypertrophy 25coronary vasoconstriction, endothelial dysfunction 26 — 28platelet activation, and the production of pro inflammatory cytokines 2930 see Table 1.
The potential consequence of this is an elevated risk in ventricular arrhythmias 31 and MI Possible mechanisms whereby depression confers elevated cardiac risk.
This is likely to be multifactorial including sympathetic activation, hypothalamic—pituitary activation, endothelial dysfunction, platelet activation, proinflammatory cytokines, and atherosclerosis development along with cardiac vascular and rhythm abnormalities. Summary of main findings in mechanisms of MDD and cardiac risk. Behavioural and Lifestyle Factors It is well established that there are number of behavioral and lifestyle factors, which are present in MDD patients that can increase the chance of developing CHD These include increased rates of smoking, alcohol intake, physical inactivity, and obesity As seen with other medical conditions, major depression predicts poorer adherence responses in CHD patient to medications 41lifestyle 42 — 44and rehabilitation programs Therefore, we are likely to see the depressed CHD patient being less motivated and adherent to cardiac rehabilitation programs.
MDD also makes it less likely to engage in lifestyle modification after a major cardiac event to reduce the classic risk factors of CHD. We see this with regards to cigarette smoking, where MDD patients are less likely to give up smoking and there consumption is also heavier Stressful events, such as terrorist attacks 49natural disasters 50and even high stakes knockout soccer matches, have been positively associated with an increase in acute cardiovascular events Mental stress is one of the many cognitive symptoms that people with major depression suffer from.
Laboratory mental stress tests have been shown to activate sympathetic nervous outflow in the non-cardiac patient setting The cardiac sympathetic nerves are preferentially activated by such mental stress In animal models and the clinical setting 3153the significance of the activation of cardiac sympathetic cardiac fibers has demonstrated disturbances in heart rhythm, leading to increased risk of ventricular arrhythmias, decreased blood flow 54left ventricular hypertrophy 25and MI and sudden death It has been shown that in depressed CHD patients, there is an elevated resting heart rate, and this also may be due to sympathetic hyperactivity in this group of patients Thus, it is postulated that the lowered removal of noradrenalin from the cardiac sympathetic synapse enhances the sympathetic stimulation and as a consequence confers CHD risk In fact, it has been shown that there is a bimodal distribution of noradrenalin spill over in patients with MDD, with approximately one-third of patients exhibiting remarkably high levels Interestingly, it has been shown that there is an elevated serotonin turnover in MDD patients who have not yet been treated with antidepressants, which is associated with the short allele of the serotonin transporter This short allele has been also associated with increased urinary noradrenalin levels and therefore sympathetic over activity Hypertension is an established risk factor for the development of CHD.
Essential hypertension is often triggered and maintained by mental stress. The processes here include reduced uptake of noradrenalin 35 and activation of brain noradrenergic pathways and noradrenalin release from the heart. We have seen other psychogenic causes of hypertension with the well-known phenomenon of white coat hypertension, which persists after numerous visits 58where you would traditionally expect some form of desensitization to occur and blood pressures to normalize.
With regards to the parasympathetic system, a further possible mechanism linking MDD and CHD includes heart rate variability as a marker of vagal activity Decreased heart variability 60 — 62 is associated with post-infarct mortality 63 — Heart rate variability is modulated by the cardiac vagus and has been described in MDD patients Disturbance of the Hypothalamic—Pituitary—Adrenal Axis Major depressive disorder has been implicated in the stress-induced activation of the HPA axis Elevated levels of cortisol have repeatedly been found in MDD patients 3767 This hypercortisolemia causes an increased risk of a metabolic syndrome type state, which includes glucose intolerance, hyperlipidemia, and increased visceral fat mass 69 — This metabolic syndrome not only confers a higher risk of cardiovascular disease 72 and diabetes 73 but has also been shown to drive sympathetic activation Platelet, Inflammatory and Autoimmune Mechanisms Stress and anxiety, both common symptoms of major depression, can contribute to atherosclerosis Increased platelet activation and endothelial dysfunction have been implicated as a potential pathophysiological pathway linking MDD and CHD 75 Prolonged mental stress, which is commonly experienced in those suffering from major depression, has been shown to induce prolonged endothelial dysfunction 27 This endothelial dysfunction has been shown to be one of the early signs of future cardiovascular deterioration In fact, oxidative stress itself has been described in numerous psychiatric illnesses Antiplatelet medication, such as aspirin, has long been a mainstay of preventative treatment of CHD As stated, depression has been implicated with increased platelet reactivity 80which will increase the relative risk of thrombus formation and arterial occlusion MDD is associated with raised platelet serotonin levels, which promotes clotting Women can make several lifestyle changes to reduce the risk of heart disease, including: Quit or don't start smoking.
Maintain a healthy weight. Eat a healthy diet that includes whole grains, a variety of fruits and vegetables, low-fat or fat-free dairy products, and lean meats.
Broken-hearted women: the complex relationship between depression and cardiovascular disease.
Avoid saturated or trans fat, added sugars, and high amounts of salt. Women also need to take prescribed medications appropriately, such as blood pressure medications, blood thinners and aspirin. And they'll need to better manage other conditions that are risk factors for heart disease, such as high blood pressure, high cholesterol and diabetes.
Exercise to reduce the risk of heart disease in women In general, everybody should do moderate exercise, such as walking at a brisk pace, on most days of the week.
The Department of Health and Human Services recommends minutes a week of moderate aerobic activity, 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. That's about 30 minutes a day, five days a week.
Heart disease in women: Understand symptoms and risk factors - Mayo Clinic
For even more health benefits, aim for minutes of moderate aerobic activity or minutes of vigorous aerobic activity a week. That's about 60 minutes a day, five days a week. In addition, aim to do strength training exercises two or more days a week. If you can't get all of your exercise completed in one session, try breaking up your physical activity into several minute sessions during a day. You'll still get the same heart-health benefits.
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Interval training — in which you alternate short bursts of intense activity with intervals of lighter activity — is another exercise alternative you might try. For example, you could incorporate short bursts of jogging or fast walking into your regular walks.
Interval training may help you burn more calories than continuous exercise, and it can help you maintain a healthy weight and keep your heart healthy. You can make other small changes to increase your physical activity throughout the day.
For example, try taking the stairs instead of the elevator, walking or riding your bicycle to work or to do errands, or doing situps or pushups while watching television. What's a healthy weight? What's considered a healthy weight varies from person to person, but having a normal body mass index BMI is helpful.
BMI is a measurement calculated from height and weight. It helps you see if you have a healthy or unhealthy percentage of body fat. A BMI of 25 or higher can be associated with an increased risk of heart disease.
Waist circumference also is a useful tool to measure whether or not you're overweight. Women are generally considered overweight if their waist measurement is greater than 35 inches 89 centimeters. Losing even a small amount of weight can help by lowering your blood pressure and reducing your risk of diabetes — both of which increase your risk of heart disease.
Is the treatment for heart disease in women different than in men? Generally, heart disease treatment in women and in men is similar. Treatment may include medications, angioplasty and stenting, or coronary bypass surgery.Congenital Heart Disease: Many Genes Lead to a Broken Heart
Angioplasty and stenting, commonly used treatments for heart attack, are effective for both men and women. However, women who don't have typical chest pain are less likely to be offered these potentially lifesaving options.
And, in women, if heart symptoms are mainly caused by coronary microvascular disease, treatment generally includes healthy lifestyle changes and medications. Doctors may recommend cardiac rehabilitation to improve health and recover from heart disease. Taking aspirin to prevent heart disease in women Guidelines from the American Heart Association AHA urge women to be more aggressive about cutting their cardiovascular disease risk.
For some women, this includes a daily aspirin. But, the routine use of daily aspirin therapy to prevent heart disease in low-risk women younger than 65 years old isn't recommended. Doctors may recommend that women older than 65 years take a daily milligram aspirin to help prevent heart disease if their blood pressure is controlled and the risk of digestive bleeding is low. Aspirin might also be considered for at-risk women younger than 65 years for stroke prevention.