The impact of major depression on heart rate variability and endothelial dysfunction in patients with stable coronary
Esra Aydin Sunbul1, Murat Sunbul2, Huseyin Gulec1
1Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey.
Insights
Major depression significantly impacts cardiac autonomic function and endothelial function in coronary artery disease (CAD) patients. Depressive symptoms correlate with reduced heart rate variability and impaired flow-mediated dilation, highlighting the need for clinical attention.
Area of Science:
- Cardiology
- Psychiatry
- Vascular Biology
Background:
- Depression is a significant independent risk factor for cardiovascular diseases.
- Cardiac autonomic dysfunction and inflammation are potential biological mechanisms linking depression and cardiovascular disease.
- Endothelial dysfunction is crucial in the development of atherosclerosis.
Purpose of the Study:
- To investigate the impact of major depression on heart rate variability (HRV) and endothelial dysfunction.
- To assess cardiac autonomic function and vascular health in patients with stable coronary artery disease (CAD) and major depression.
Main Methods:
- Compared 65 CAD patients with major depression to 54 CAD patients without depression.
- Utilized transthoracic echocardiography, flow-mediated dilation (FMD) measurement, and 24-h Holter monitoring for HRV.
- Assessed inflammatory markers and depressive symptom severity using the Montgomery-Asberg Depression Scale (MADRS).
Main Results:
- HRV parameters were significantly lower in patients with major depression compared to controls.
- Flow-mediated dilation (FMD) was significantly reduced in the depressed CAD group.
- MADRS scores correlated with HRV (pNN50) and FMD, independent of age and gender.
Conclusions:
- Major depression is linked to impaired cardiac autonomic function and endothelial dysfunction in CAD patients.
- The severity of depression (MADRS score) independently predicts reduced HRV and FMD.
- Clinicians should prioritize evaluating depressive symptoms in patients with CAD.
Background:
Depression is an independent risk factor in cardiovascular diseases. Changes in the cardiac autonomic functions and pro-inflammatory processes are potential biological factors. Endothelial dysfunction plays an important role in the etiopathogenesis of atherosclerosis. Our objective was to evaluate the impact of major depression on heart rate variability and endothelial dysfunction in patients with stable CAD.
Methods:
The study group included 65 CAD patients with a diagnosis of major depression and 54 CAD patients without major depression. All study population underwent transthoracic echocardiography, measurement of flow mediated dilatation (FMD) and 24-h holter recording for heart rate variability (HRV). Blood samples were drawn to determine the inflammatory parameters. Severity of depressive episode was assessed by Montgomery-Asberg Depression Scale (MADRS).
Results:
The distribution of age and sex was similar in the patient and control groups (P=0.715, 0.354, respectively). There was no significant difference in medications used between the groups. Echocardiographic parameters were similar between the groups. Inflammatory parameters were also similar between the groups. HRV parameters were significantly lower in the patient group than controls. The absolute FMD value and percentage FMD were significantly lower in the patient group than controls (P<0.001). The MADRS score correlated with pNN50 in both groups (P<0.05), and with FMD in the control group (P<0.001), even after adjusting for age and gender (P<0.001).
Conclusions:
MADRS score was an independent predictor of pNN50 level, percentage and absolute FMD values regardless of age and gender. Clinician should pay more attention for evaluation of depressive patients with CAD.
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