Treatment of depression reduces cardiovascular risk


Patients managing depression with psychotherapy have a reduced risk of cardiovascular disease. This is the result of a large cohort study conducted in the UK. “People whose symptoms of depression improved after treatment were 10% to 15% less likely to experience a cardiovascular event than those who did not,” the authors report. European Heart Journal.

“There are hypotheses and some indications that treating depression may help prevent cardiovascular disease, but there is no conclusive evidence,” said Heike, a professor of health psychology who focuses on prevention and rehabilitation. Dr. Suderna said.Trier, Trier, Germany Medscape Medical News. “Of course, this retrospective study also does not prove causation, but it is the first large-scale study to provide plausible evidence that this may be the case.”

higher cardiovascular risk

Both depression and cardiovascular disease are highly prevalent. Therefore, they can occur independently of each other. However, research data indicate that there are interactions between diseases. Cardiovascular disease causes depression, and depression causes cardiovascular disease.

“People with major depressive disorder have an approximately 72% higher risk of cardiovascular disease,” said lead author Celine El Baou, Ph.D., research assistant at University College London, UK. medscape. “Our research demonstrates that successful outcomes of evidence-based psychological interventions extend beyond psychological health and may provide long-term physical health benefits, especially for people under the age of 60. I suggest,” she added.

7-year follow-up

El Baou and her research group analyzed data from 636,955 adults who were receiving psychotherapy for depression (such as cognitive-behavioral therapy) and had no initial cardiovascular disease. These adults had an average age of 55 years and two-thirds were female.

Improvement in depressive symptoms was measured as a decrease in Patient Health Questionnaire-9 (PHQ-9) score (≥6 points) without worsening of anxiety symptoms. The latter criterion was intended to prevent treatment from being considered successful when improvement in depression coincided with worsening anxiety. Patient follow-up began 1 year after the last treatment session and lasted for a median of 3.1 years and up to 7 years.

Reduced cardiovascular risk

Depressive symptoms improved in 59% of patients. Cardiovascular events occurred in 49,803 subjects and 14,125 died. Improvement in depression was associated with his 12% reduction in cardiovascular disease risk.

The risk of coronary heart disease (CHD) was reduced by 11% and the risk of stroke was reduced by 12%. All-cause mortality was 19% lower in patients who improved symptoms than in those who failed psychotherapy.

In their analyses, the researchers considered variables such as age, ethnicity, gender, socioeconomic status, and other health limitations that may influence associations.

lifestyle, inflammatory process

The study did not show how improvement in depression translated to reduced cardiovascular risk. But Spaderna offered him two possibilities. “One mechanism is that ameliorating depression may also improve the patient’s lifestyle, and this is especially true for physical activity.” Both are well proven here.”

On the other hand, another theory is that depression promotes inflammatory processes in the body, including in the walls of blood vessels. This can also affect cardiovascular health, Spaderna added.

young subject

El Baou and co-authors also reported that the association between improved depression and risk of cardiovascular disease was significant in the 45-60 year old age group. In this group, improvement in depression was associated with her 15% reduction in cardiovascular disease. There was only a 6% reduction in patients over the age of 60.

In addition, with respect to all-cause mortality, people aged 45 to 60 years benefited more from reduced symptoms of depression. Their mortality risk he decreased by 22%. This reduction was only 15% in adults over the age of 60.

“Our results are consistent with previous studies in that: [they show that] Cardiovascular risk reduction interventions in general may be less effective in the elderly,” commented El Baou.

“Even if depression improves, older people may find it difficult to lead more active lives,” Spaderna said. But it will still be worth it. “Even in older adults, behavioral changes can have positive effects on health and longevity.”

However, all-cause mortality can also affect older people. “Older people often have other conditions that can affect cardiovascular risk, such as hypertension and diabetes. In this case, improving depression may not have a significant impact on cardiovascular health. There is a possibility,” Professor Spaderna added.

Access to psychotherapy

The authors acknowledged that the study could not conclusively demonstrate that improvement in depression led to a reduction in cardiovascular disease. No data were collected, but lifestyle factors such as smoking and physical inactivity may also have influenced the results.

Nonetheless, El Baou believes that “facilitating access to psychotherapists is crucial to improving mental and physical health.” This is especially true in communities where access to psychotherapy is difficult and at the same time high risk of cardiovascular disease.

“It is unfortunate that in Germany many patients find it very difficult to find a cure,” said Spaderna. “This needs to be fixed ASAP.” Psychologists say people need to be more aware of the fact that mental illnesses such as depression need to be treated early. “The correlation between depression and cardiovascular disease is still not well understood,” she says.

This article was translated from the German version of Medscape.



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