The link between depression and atherosclerosis through the pathways of inflammation and endothelium dysfunction
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Christina Chrysohoou1, Natasa Kollia2, Dimitris Tousoulis1
1First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
Insights
Depression and vital exhaustion significantly elevate cardiovascular disease risk. This review explores inflammation and endothelial dysfunction as key biological links, suggesting a complex feedback loop between depression and atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Psychiatry
- Immunology
Background:
- Major depressive disorder and sub-syndromal depressive symptoms increase cardiovascular morbidity and mortality.
- Vital exhaustion, a state of emotional and physical overstrain, shares overlapping characteristics with depression and is linked to cardiovascular risk.
- The precise pathophysiological mechanisms connecting depressive symptoms to atherosclerosis remain incompletely understood.
Purpose of the Study:
- To review the role of inflammation and endothelial dysfunction in the relationship between depressive symptoms and atherosclerosis.
- To explore the bidirectional interaction between systemic inflammation and psychological factors in cardiovascular disease.
Main Methods:
- Literature review of studies investigating biological pathways linking depression and atherosclerosis.
- Examination of research on inflammation, endothelial dysfunction, and their interplay with depressive symptoms.
- Analysis of evidence regarding the directionality of the association between inflammation and depression.
Main Results:
- Systemic inflammation and endothelial dysfunction are implicated as biological mediators in the depression-atherosclerosis link.
- Evidence suggests a complex interplay between psychological factors and inflammatory processes.
- The relationship between inflammation and depression may be bidirectional, with distinct biological pathways for each direction.
Conclusions:
- Inflammation and endothelial dysfunction represent critical biological factors contributing to the elevated cardiovascular risk associated with depressive symptoms.
- A feedback relationship between depression and inflammation is suggested, necessitating further research into specific biological pathways.
- Clarifying these mechanisms is crucial for developing targeted interventions for cardiovascular disease prevention in individuals with depressive symptoms.
Abstract:
A large body of evidence suggests that depression increases the risk of cardiovascular morbidity and mortality. The elevated risk associated with depression is not limited to clinical major depressive disorder but also extends to sub-syndromal depressive symptoms and constructs with overlapping characteristics, such as vital exhaustion. Multiple pathophysiological pathways are involved in the relationship between depressive symptoms and atherosclerosis and its clinical manifestations and progression. These underlying mechanisms are not yet fully understood and need further clarification. This review examines inflammation and endothelium dysfunction as potential biological factors involved in the relationship between depressive symptoms and atherosclerosis. It has been reported that systemic inflammation and psychological factors interact through complex pathophysiological and behavioral mechanisms and one question that has been raised concerns whether the inflammation drives depression or vice versa, or whether the association is merely coincidental. Although further investigation is needed, including well-designed prospective studies, to address this question thoroughly, it seems that there is a feedback relationship, although the biological pathways of each direction may be distinct.
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