[Psychological disorders and cardiovascular diseases]

The present review is aimed at critically analyzing the available literature on the relationship between psycho-emotional disorders and cardiovascular disease, and the effects of antidepressant and antianxiety drugs on clinically relevant outcomes. An extensive Medline search has been conducted between January 1966 and December 2006 using "coronary artery disease", "cardiac disease", "depression", "anxiety", and "emotional disorders" in all their possible combinations as search terms. Among patients with cardiovascular disease, depression and/or anxiety are very common, with a prevalence ranging from 15% to 50%. Many epidemiological studies with extended periods of follow-up have shown that psycho-emotional disorders (in particular, depressive disorders) are associated with increased risk of incident cardiovascular events, rehospitalization, all-cause and cardiovascular mortality both in patients with overt cardiac disease and in the general population. Pathophysiologic reasons supporting this association are represented by unhealthy lifestyle (i.e. persistent smoking habits, inadequate adherence to medical prescriptions, etc.) associated with psycho-emotional disorders, and also by functional alterations of the hypothalamic-pituitary-adrenal axis, platelets, and autonomic nervous system. Some observational studies and clinical trials with small numbers of patients included suggest that these alterations are effectively antagonized by some antidepressant/antianxiety drugs. However, no randomized clinical trial has yet demonstrated that such drugs can reduce the increased risk of unfavorable clinical events associated with psycho-emotional disorders. Despite a proven association of psycho-emotional disorders with an increased cardiovascular risk, and the demonstration that several antidepressant/antianxiety pharmacological agents favorably affect the pathophysiologic alterations associated with such disorders, randomized clinical trials with adequately large sample size and prolonged follow-up are necessary to clarify whether drug treatments may reduce the increased cardiovascular risk of patients affected by depression and/or anxiety.