Jesse Stewart, Ph.D., associate professor of psychology in the School of Science at Indiana University-Purdue University Indianapolis, and two colleagues have received a $2.2 million National Institutes of Health grant to investigate the links between depression, depression treatment and cardiovascular disease in adults with HIV. With the success of antiretroviral therapy, cardiovascular disease is now the leading cause of death in HIV-infected adults.
The four-year grant from the National Heart, Lung and Blood Institute to clinical health psychologist Stewart and the two other principal investigators -- infectious disease specialist Samir Gupta, M.D., associate professor of medicine in the IU School of Medicine, and internist Matthew Freiberg, M.D., associate professor of medicine in the Vanderbilt University School of Medicine -- supports two projects.
The first is an observation study of 1,525 HIV-infected adults from the national Veterans Aging Cohort Study. To examine how depression may increase the risk of cardiovascular disease in HIV-infected individuals, the investigators will test whether depression is associated with high blood levels of inflammatory and clotting proteins that are known to predict future heart attacks. They will also test whether depressed adults treated with antidepressants or psychotherapy have lower levels of these proteins than those who did not receive treatment for their depression.
The second project supported by the grant explores whether depression treatment could be effective in reducing the risk of cardiovascular disease in HIV-infected adults. In a randomized controlled trial of 110 depressed adults treated with antiretroviral therapy, half will receive usual depression care while the others will also receive an evidence-based, computerized, cognitive-behavioral therapy for depression called Beating the Blues, used by England's National Health Service and recently adapted for use in the U.S. In previous work, Stewart and his collaborators have validated this computerized psychotherapy for depression, which can be confidentially and inexpensively administered.
During the newly funded study, two IUPUI clinical psychology doctoral students will coordinate the delivery of Beating the Blues. They also will track depression progress in the HIV-infected participants.
Depression is common among HIV-infected patients, with rates ranging from 20 to 40 percent. Cognitive-emotional symptoms of depression include sadness and loss of interest or pleasure. Fatigue, appetite changes and sleep disturbance are among the physical symptoms.
"We are excited because, if these two projects are successful, we may be able to provide clinicians caring for HIV-infected patients with a potent new tool -- depression treatment -- to lower the risk of or prevent heart attacks and strokes," said Stewart, who has had a long-term research interest in the link between depression and cardiovascular disease.
In 2008, he reported that the strength of the association between depression and future cardiovascular disease is similar to that of traditional risk factors like smoking, high blood pressure and high cholesterol in the general population. In 2014, he published a study that found that treatment of depression before any apparent signs of cardiovascular disease can decrease the risk of future heart attacks and strokes by almost half in depressed primary care patients.
"We are expanding our work from primary care patients -- a general population -- to a specific group -- adults with HIV," Stewart said. "In the future, we may extend this line of research to determine if depression treatment can help prevent cardiovascular disease in other patient groups."
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