Depression, Inflammation Are Independent Risk Factors for Heart Disease in Women (11/15/2007)

Depression is common among persons with cardiovascular disease, especially younger women, and researchers have linked both depression and heart disease with inflammation, the result of an over-active immune system.

However, a nationwide team of researchers reports that depression and inflammation don't add up to make heart disease worse. The findings were published this week online in the Journal of the American College of Cardiology.

"This study confirms depression as an important risk factor for heart disease in women," says lead author Viola Vaccarino, MD, PhD, professor of medicine (cardiology) at Emory University School of Medicine and professor of epidemiology at Emory's Rollins School of Public Health. "But we were surprised to find that inflammation is a totally independent factor. We must look at other mechanisms."

The data comes from the WISE (Women's Ischemia Syndrome Evaluation) study, sponsored by the National Heart, Lung, and Blood Institute. The researchers followed 559 female cardiac patients from six states over six years ending in 2006.

"The idea behind this was to figure out the underlying mechanisms that lead to greater cardiovascular risk for women with depression," says Dr. Vaccarino, a member of the Emory Heart and Vascular Center.

The answers could guide doctors in treating patients with various medications - for example, anti-inflammatory drugs if inflammation turned out to be the key - to prevent depression and a worsening of their heart conditions, she says.

In the WISE study, patients were monitored for symptoms of depression and two markers of inflammation in the blood. Doctors tracked patients' severity of cardiovascular disease with the number of heart and stroke related hospital visits and survival over six years.

Women with depression or some depressive symptoms generally had elevated levels of both markers of inflammation in their blood, the study found.

Women with depression were almost three times as likely to have heart and stroke related hospital admissions and death, compared with women without depression. However, incorporating the data on inflammatory markers explained little of this extra risk due to depression, the researchers found.

Only one previous European study examined whether inflammation might link depression and heart disease in men and also found a similar result, says Dr. Vaccarino.

"The results continue to emphasize how important it is for doctors to monitor female cardiac patients for depression, but they will point future investigations in a different direction in order to discover the mechanisms of this increased risk," she says.

Besides inflammation, other mechanisms that may explain the link between depression and cardiovascular disease are increased blood clotting as a result of stress, disturbances of the autonomic function of the heart, or separate genetic influences, she says.

In addition to Dr. Vaccarino, the research team included Leslee Shaw, PhD, from Emory, B. Delia Johnson, PhD, Steven Reis, MD, and Sheryl Kelsey, PhD, from the University of Pittsburgh, David Sheps, MD, from the University of Florida, Vera Bittner, MD, from the University of Alabama, Thomas Rutledge, PhD, from the University of California, San Diego, George Sopko, MD, from the National Heart, Lung, and Blood Institute in Maryland and C. Noel Bairey Merz, MD, from Cedar-Sinai Medical Center, Los Angeles.

Note: This story has been adapted from a news release issued by Emory University

Post Comments: