Treating Depression Could Reduce Cardiac Risk

Depression is associated with increased cardiovascular risk and prompt effective treatment may reduce the risk of future major adverse cardiac events (MACE), according to observational evidence from a new study.

Researchers studied 7550 patients who completed 2 patient health questionnaire (PHQ)-9 surveys. They stratified them into 4 groups: no depression (first and last PHQ-9 score <9, n=3286), no longer depressed (first PHQ-9 >10 with improvement [reduction] in score of >5 and last PHQ-9 score <9, n=1542), remained depressed (first and last PHQ-9 >10, n=1987), and became depressed (first PHQ-9 <9 with an increase score >5 and last PHQ-9 >10, n=735). Investigators then followed patients from the last PHQ-9 for MACE (death, coronary artery disease diagnosis, myocardial infarction, stroke, and heart failure hospitalization).
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Patients averaged 57±12 years (70% female). History of coronary artery disease, stroke, and heart failure were similar between groups. MACE frequency among those with no depression, no longer depressed, remained depressed, and became depressed were 4.8%, 4.6%, 6.0%, and 6.4%, respectively (p-trend=0.03). After adjustment, those no longer depressed had a similar MACE risk as those never depressed and those with depression (remained and became) were at an increased risk.

“I was surprised there was a decrease in risk in such a short amount of time among patients who initially had depressive symptoms but then no longer had depressive symptoms at their last assessment,” said lead study author Heidi May, PhD, a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute, Salt Lake City. “This risk became similar to that of patients that had no depressive symptoms on their first and last depression survey.”

She said that she thinks this study shows the evaluation of depressive symptoms needs to be performed at all patient visits since changes can have immediate consequences.

“If patients are found to have depressive symptoms, treatment of these symptoms are needed,” said May, who notes a follow-up visit (e.g., 60 days) should be made to evaluate the symptoms and whether treatment modifications are necessary.

May is currently involved in a variety of studies involving depression, including one that incorporates depressive symptoms, other risk factors, and some lab results into a single score that then can be used to help predict poor outcomes, such as chronic diseases and hospitalizations.

“We hope that by using these risk scores, we can identify patients at higher risk and treat them more aggressively so their risk is reduced,” May said.

-Mike Bederka

Reference:

May HT, Brunisholz K, Horne B, et al. Can effective treatment of depression reduce future cardiovascular risk? Paper presented at the American College of Cardiology Scientific Session, Chicago. April 2, 2016.