DEPRESSION AS HEART DISEASE RISK FACTOR

Depression should join the ranks of obesity, diabetes, hypertension, and smoking as an official heart disease risk factor, according to an expert panel convened by the American Heart Association (AHA).

The recommendation is based on an extensive literature review examining the risks for depression conducted by the panel, which included Robert M. Carney, PhD, professor of psychiatry at the Washington University School of Medicine in St. Louis, Missouri.

The AHA Scientific Statement notes that the combined findings support the call to formally "elevate depression to the status of a risk factor" for adverse outcomes, such as all-cause and cardiac mortality, in patients who have acute coronary syndrome (ACS).

"It was very gratifying to see this recommendation at this time and know that the potential risks are appreciated," Dr. Carney, who is also a member of the AHA Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing, told Medscape Medical News.

"We're hoping that eventually we'll be able to show that treating depression will improve survival and heart health. Although that story remains to be done, I'm happy we've come this far," Dr. Carney added.

he Scientific Statement was published onlineFebruary 24 in Circulation.

Deep Delve

According to the investigators, approximately 20% of all patients who have ACS, myocardial infarction (MI), or unstable angina also meet clinical criteria for major depression, and many more of these patients have depressive symptoms.

As reported by Medscape Medical News, recent studies have shown that chronic episodes of depression may be causally linked to an increased risk for coronary heart disease and that major depression is now the second leading cause of disability and is a major contributor to ischemic heart disease.

Last year, Angelos Halaris, MD, PhD, professor in the Department of Psychiatry and Behavioral Neurosciences at Loyola University Stritch School of Medicine in Maywood, Illinois, went so far as to suggest the creation of a new "psychocardiology" subspecialty that would specifically address the association often found between depression and heart disease.

The current researchers note that although many studies over the years have shown a strong association between depression and increased morbidity after experiencing ACS, depression has not been recognized as a formal risk factor by national health organizations.

Dr. Carney and colleagues published their first article showing that depression doubles the risk for cardiac events in patients with recently diagnosed heart