Term Paper: Long-Term Depression and Increased Risk for Heart

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Long-Term Depression and Increased Risk for Heart Disease Later in Adulthood Compared to Individuals Who Do Not Have Depression: Systemic Review

Individuals with depression have been found to have a higher risk in later adulthood of developing heart disease than are individuals who do not have depression.

The objective of this study is to examine whether individuals who have long-term depression are at an increased risk for heart disease later in their adulthood compared to individuals who do not have depression.

The work of Kop, Synowski and Gottlieb (2010) report that depression "is associated with an increased risk of adverse cardiovascular disease and heart failure progression. The largest published meta-analysis to date provides a review of 54 observational studies and indicates that depression is consistently predictive of new-onset (incident) cardiac events in individuals free of CVD as well as recurrent events in patients with a known diagnosis of CVD." (p.23) it is additionally reported that the "magnitude of the CVD risk associated with depression is approximately comparable to that of traditional risk factors, such as hypercholesterolemia and hypertension." (Kop, Synowski and Gottlieb, 2010, p.23) Kop, Synowski and Gottlieb (2010) additionally report that the most common and well-documented psychological factor associated with heart failure progression (HF) is that of depression. (Kop, Synowski and Gottlieb, 2010, paraphrased)

A scientific advisory was published by the American Heart Association in 2008, which states recommendations for "systematic detection and treatment for depression in patients with CVD including screening; subsequent referral for comprehensive evaluation for depression diagnosis and management; and monitoring for adherence; treatment safety, and efficacy." (Kop, Synowski and Gottlieb, 2010, p. 23) There is a greater than 2-fold risk for several reported adverse outcomes for individuals with clinical major depressive disorder and subthreshold depressive symptoms…including mortality." (Kop, Synowski and Gottlieb, 2010, p.23)

Kop, Synowski and Gottlieb state that the etiology of depression in heart failure is affected by three primary components that are known to accompany both conditions on a frequent basis: (1) symptomatology (eg, fatigue, sleep problems); and (2) behavioral characteristics (eg. Reduced physical activity) and (3) shared biological processes such as neurophoromonal dysregulation and inflammation." (2010, p.23) There are nine defining characteristics of heart failure and depression, which overlap. The symptoms and signs, behavioral factors and biological processes of heart failure and depression are shown in the following table labeled Figure 1.

Figure 1 - Heart Failure and Depression: Symptoms and Signs, Behavioral Factors and Biological Processes

Source: Kop, Synowski and Gottlieb (2010)

Reports state that the argument is held that depressive symptoms in heart failure are "secondary to the severity of underlying disease or the pharmacologic treatment of HF or CVD. However, there is little support for this notion because poor left ventricular (LV) pump function, angiographically documented coronary artery disease severity and inducibility of ischemia are minimally associated with depressive symptoms." (Kop, Synowski and Gottlieb, 2010, p.24) it is reported that "evidence of a relationship between depression and subclinical CVD severity is also inconsistent when examining noninvasive indices such as carotid intima-media thickness and coronary calcification." (Kop, Synowski and Gottlieb, 2010, p.24) it was reported by one study that individuals with poor cardiac pump function or left ventricular ejection fraction "are at risk for developing future depressive symptoms." (Kop, Synowski and Gottlieb, 2010, p.24) it is reported that studies on the link between depression and natriuretic peptides "have been missed with positive, but more commonly negative findings." (Kop, Synowski and Gottlieb, 2010, p.24) Aspects of heart failure including myocardial fibrosis have been found to be adversely affected by depression. (Kop, Synowski and Gottlieb, 2010, paraphrased)

It is believed that cardiac medications including beta-adrenergic blocking agents are likely to play a role on both the onset and sustained presence of symptoms of depressive in heart failure…" (Kop, Synowski and Gottlieb, 2010, p.24) However, there has been little in the way of empirical research findings to associate beta-blockers with increased risk of depression. It is reported that the etiology of heart failure involves more than the common features of both conditions and includes the following; (1) genetic vulnerability factors; (2) central nervous system abnormalities; (3) socio-environmental experiences associated with psychological distress; and (3) cognitive vulnerability factors and negative attributional styles. (, p.26) the reported prevalence of depression and heart failure is reported at 15% to 40% stated to be greater than the prevalence rates observed in patients with CVD without heart failure, stated at 10% to 25% or the general population stated at 2% to 9%. ( p. 27) it is reported that observations from the 'Enhancing Recovery in Coronary Heart Disease trial' indicate that "the presence of heart failure among subjects after myocardial infarction is associated with increased depression, supporting the additive effects of coronary heart disease and heart failure for depression." ( p. 27) in addition, it is reported that when the individual has depression, the severity at the time of the acute Heart Failure worseness and is related to functional heart failure severity. The diagnosis of heart failure alone is not commonly linked to increased levels of depression. It is reported however; that "concurrent symptoms and limitations promote the presence of depression." (, p.28)

The work of Davidson (2012) relates that depression, both diagnosed and self-reported "continues to mark very high risk for recurrent acute coronary syndrome or for death in patients with coronary heart disease." (p.1) While there are many mechanisms that have been held as implications in the link existing between heart disease and depression, it is reported that "randomized controlled trials of depression treatment are beginning to delineate the types of depression management strategies that may benefit the many coronary heart disease patients with depression." (Davidson, 2012, p.1) in fact, according to Davidson (2012) depression is "quickly becoming the leading cause of years of life lived with disability worldwide and has a particularly large impact on compromised health when comorbid with a chronic medical disorder." (2012, p.1) There are approximately seven million individuals in the United States reported as "living with coronary heart disease (CHD)" who are also know to suffer from "clinically significant depression" with more than half of a million new cases being reported each year. (Davidson, 2012, p.1) the presence of a disorder of depression appears to be a "prognostic marker of CHD recurrence and all-cause mortality." (Davidson, 2012, p.1)

Major risk factors for heart attack include: (1) high blood pressure levels of LDL-cholesterol combined with low levels of HDL cholesterol; (2) high blood pressures; (3) atherosclerosis; (4) type a personality; (5) high stress lifestyle; and (6) cigarette smoking. (2013, p.1) However, the risk factor that is rarely mentioned is that of depression. It is reported that the results of a new study reported by researchers at John Hopkins University relate that the individual who has experienced a major depressive event with a history of dysphoria or more than two weeks of sadness that is profound in nature is at increased odds of a subsequent heart attack at a rate of four times higher than individuals who do not have a history of serious depression. (Pratt, et al., 1996, paraphrased) the work of Ariyo, Hann, and Tangen (2001) reports a study with 4493 participants ages 65-98 years of age, stated to be 39% men and 61% women, all who had no cardiovascular disease recruited from medical eligibility lists. It is reported that the study assessed depression at baseline and CHD was defined as the fist occurrence of "angina, myocardial infarction, angioplasty, coronary artery bypass grafting or coronary death and all cause mortality." (p.1) the results of the study reported the mean depression score being assessed for each participant at the time the CHD event occurred or at death for six years follow up. The study conclusions state "Every 5 point increase in mean depression score on a 0 -- 30 point scale was associated with a 15% increase in risk of developing CHD (unadjusted and multivariate analysis, p=0.006). Increases of 16% (unadjusted, p<.001) and 29% (multivariate, p=0.006) were observed in risk of death." ( p.1)

The work of Hendrick (2010) states that patients suffering from depression and who have heart disease "are almost five times as likely to die as people who are mentally and physically healthy." (p.1) According to Hendrick (2010), 6,000 adults and their related data were examined by researchers in the United States, England, France, and Finland and findings demonstrated that nearly 14.9 of the study participants scored high on a test designed to measure the level of depression in the participants. Of those with heart disease, 20% were determined to have depression. This compares to only 14% of the participants who did not have heart disease. During the study, which lasted five and a half years, a reported 170 individuals died with a heart attack or stroke being the cause in 47 of the deaths. Findings in the study include that patients with coronary heart disease alone "were 67% more likely to die of any cause" and people who were depressed but healthy otherwise "were twice as likely to… [END OF PREVIEW]

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