According to Huffman et al (2013)1, patients with coronary artery disease, heart failure, atrial fibrillation, and implanted cardiac defibrillators are all at greatly increased risk of depression compared to healthy individuals. but what is less known but equally true is the bi-directional relationship of these conditions, namely how a patient’s mental health can have an impact upon their risk of cardiovascular disease.

Research from Harvard Medical School summarized the following:-

  • In one study, major depression preceded acute coronary syndrome by more than 30 days in 53% of patients.2
  • In another study, nearly 50% of patients had thoughts that life was not worth living two weeks before hospitalization for a cardiac condition.3
  • A meta-analysis concluded that whether pre- or post-cardiac event, depression is prevalent among coronary heart disease patients and is “hazardous.”4

One 1-year study on all-cause mortality and cardiovascular mortality examined more than 3,400 middle-aged men.5 The results indicated that the presence of depressed mood and exhaustion is a middle-ranking risk factor for all-cause and CVD mortality, comparable to hypercholesterolemia and obesity.5 A 2018 study of 1,075 women found a significant prevalence of untreated and under-treated depressive symptoms among women with, or at high risk of developing, cardiovascular disease.6

It would seem from these pieces of research that an wholistic approach to patient care could yield better outcomes all round.  A functional medicine approach that recognizes a patient’s mental and emotional wellbeing as being equally important in the overall diagnostic process alongside a cardio-metabolic assessment would man that not only is the condition better understood, but the patient-practitioner relationship is strengthened and therefore compliance in making the necessary lifestyle changes is likely to be higher.

References

  1. Huffman JC, Celano CM, Beach SR, Motiwala SR, Januzzi JL. Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol. 2013;2013:695925. doi:10.1155/2013/695925
  2. Glassman AH, Bigger JT, Gaffney M, Shapiro PA, Swenson JR. Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry. 2006;63(3):283-288. doi:10.1001/archpsyc.63.3.283
  3. Huffman JC, Mastromauro CA, Sowden GL, Wittmann C, Rodman R, Januzzi JL. A collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes. Psychosomatics. 2011;52(1):26-33. doi:10.1016/j.psym.2010.11.021
  4. Leung YW, Flora DB, Gravely S, Irvine J, Carney RM, Grace SL. The impact of premorbid and postmorbid depression onset on mortality and cardiac morbidity among patients with coronary heart disease: meta-analysis. Psychosom Med. 2012;74(8):786-801. doi:10.1097/PSY.0b013e31826ddbed
  5. Ladwig K-H, Baumert J, Marten-Mittag B, et al. Room for depressed and exhausted mood as a risk predictor for all-cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men. Atherosclerosis. 2017;257:224-231. doi:10.1016/j.atherosclerosis.2016.12.003
  6. Bhardwaj M, Price J, Landry M, Harvey P, Hensel JM. Association between severity of depression and cardiac risk factors among women referred to a cardiac rehabilitation and prevention clinic. J Cardiopulm Rehabil Prev. 2018;38(5):291-296. doi:10.1097/hcr.0000000000000311

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