Identifying and treating depression plus exercise in African-Americans may reduce heart disease

Mar 11 2009

Identifying and treating depression, including increasing physical activity, may improve quality of life and reduce cardiovascular disease and death in African Americans, according to reports presented at the American Heart Association's 2009 Conference on Nutrition, Physical Activity and Metabolism.

In one study, researchers in the Jackson Heart Study (JHS) found high depressive symptoms were prevalent and significantly associated with low physical activity in African Americans. JHS is a population-based, longitudinal study and the largest single-site, prospective, epidemiologic investigation of cardiovascular disease among African Americans ever undertaken.

High depressive symptoms were identified by a standard depression scale and/or characterized by taking antidepressants. Physical activity scores were in the lowest quartile of the JHS Physical Activity Cohort (JPAC) survey for total physical activity, representing the sum of four index scores: active living, work (for those who were employed or did volunteer work), sport and home life.

Of the 3,092 adults (average age 54; 65 percent women; 12 percent smokers), 17 percent had high depressive symptoms. The prevalence of high depressive symptoms was significantly higher among:

• Women (20 percent compared with 10 percent in men);
• Smokers (28 percent compared with 15 percent in nonsmokers); and
• Those with low total physical activity (25 percent vs. 14 percent in higher physical activity).

Low physical activity was associated with high depressive symptoms in multivariable logistic regression analysis after controlling for age, sex, body mass index, education, income, and smoking.

"It is important to identify individuals with low levels of physical activity as well as those with depression," said Patricia Dubbert, Ph.D., lead author of the study and a psychologist with the Veterans Affairs Medical Center in Jackson, Miss. "Both indicate an individual is at greater risk for adverse health outcomes. We have effective interventions to employ when either or both are identified."

"Behavioral patterns in depressed patients are likely to further negatively impact their cardiovascular disease status," said Ermeg Akylbekova, M.S., a biostatistician for the Jackson Heart Study. "For example, depressed patients are less likely to exercise, tend to eat in a less healthy manner, and are more likely to use tobacco and alcohol. They are also less likely to take medications as prescribed or closely follow their treatment regimen, which may be a serious impediment to treating their cardiovascular condition.

"It is advisable for healthcare providers treating cardiovascular disease patients, whether cardiologists or primary care, to screen all their patients for depression. If concerns arise, a mental health professional should be consulted. Patients have to be monitored for both conditions."

A recent American Heart Association science advisory also recommends screening coronary heart disease patients for depression.