Depressed cardiac patients at added risk

Aug 14 2012

By Piriya Mahendra, MedWire Reporter

Coronary artery disease patients may have an increased risk for peripheral arterial disease (PAD) if they are depressed, study findings show.

Marlene Grenon (University of California San Francisco, USA) and colleagues found that in an analysis of 1024 participants from the Heart and Soul Study, 12% of the 199 patients who reported depressive symptoms (defined as a Patient Health Questionnaire score of ≥10) also had prevalent PAD, compared with 7% of those without depression.

Indeed, in a base model adjusted for age and gender, patients who had depression were a significant 79% more likely to also have PAD than those who did not, as reported in the Journal of the American Heart Association.

During a mean follow-up period of 7.2 years, PAD events (defined as a final diagnosis during hospitalization; ultrasonographically or angiographically demonstrated obstruction or ulcerated plaque of iliac arteries; surgery, angioplasty, or thrombolysis for PAD; or exertional leg pain) occurred in 7% of patients with depression and 5% of those without depression.

In fact, patients with depression were more than twice as likely to experience a PAD event than those without depression.

"These findings add to the growing body of research showing the importance of depression in both the development and progression of PAD," commented co-author Beth Cohen, also from the University of California San Francisco. "This also emphasizes the need for medical providers to be attentive to the mental health of their patients who have developed, or who are at risk for, PAD."

More than 5% of the association between incident PAD and depression was accounted for by factors including race/ethnicity, diabetes, congestive heart failure, high-density lipoprotein cholesterol, triglyceride levels, serum creatinine, inflammation, smoking, and physical activity level.

"We still don't know what comes first," remarked Grenon. "Is it that patients with PAD become depressed because their mobility is impaired, or that people who are depressed engage in unhealthy behaviors such as smoking and lack of exercise, and are thus more at risk of developing PAD? Or it might be a vicious cycle, where one leads to the other?"

She said that whatever the initial cause may be, lifestyle modifications such as increasing physical activity levels, eating healthily, quitting smoking, and managing stress more effectively could reduce the risk for the association.

"These lifestyle changes would be considered healthy for anyone, and would also help overall cardiovascular health," Grenon added.

"As providers, we can help patients recognize the connections between mental and physical health. This may help reduce the stigma of mental health diagnosis and encourage patients to seek treatment for problems such as depression."

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