Depression and cardiovascular disease: an update on how course of illness may influence risk
1Department of Psychiatry, The University of Iowa, Carver College of Medicine, 200 Hawkins Drive W278GH, Iowa City, IA, 52242, USA, jess-fiedorowicz@uiowa.edu.
Insights
Depression is an independent risk factor for cardiovascular disease, especially in mood disorders like bipolar disorder. Long-term mood disorder symptom burden increases cardiovascular mortality risk, necessitating integrated care.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depression is an established, yet underappreciated, risk factor for cardiovascular disease (CVD).
- The association between depression and CVD extends beyond acute coronary syndromes, affecting various mood disorders.
- Bipolar disorder may confer an even greater vascular risk compared to other depressive disorders.
Purpose of the Study:
- To review the literature linking depressive disorders to cardiovascular mortality.
- To examine how the course of mood disorders influences cardiovascular risk.
- To discuss potential mediating mechanisms and treatment implications.
Main Methods:
- Literature review of studies on depression and cardiovascular mortality.
- Analysis of the relationship between mood disorder chronicity and vascular risk.
- Exploration of proposed pathophysiological pathways.
Main Results:
- Depressive disorders are linked to increased cardiovascular mortality, with risk potentially escalating over decades.
- Symptom burden and persistence in mood disorders correlate with elevated vascular risk.
- Autonomic nervous system, HPA axis, and inflammatory cytokines are implicated as mediating factors.
Conclusions:
- Depression and mood disorders represent a significant, often neglected, risk factor for cardiovascular events.
- Optimized management of traditional CVD risk factors alongside depression treatment is crucial.
- Further research is needed to establish treatment efficacy and elucidate causal mechanisms.
Abstract:
Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary.
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