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The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease
R M Carney1, M W Rich, A teVelde
1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
Insights
Depressed patients with coronary artery disease (CAD) show higher mean heart rates, potentially due to increased sympathetic tone. This finding may explain increased health risks in this population.
Area of Science:
- Cardiology
- Psychiatry
- Psychosomatic Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality.
- Depression is a common comorbidity in CAD patients.
- The physiological mechanisms linking depression and CAD outcomes require further elucidation.
Purpose of the Study:
- To investigate the relationship between depression and cardiovascular autonomic function in patients with CAD.
- To determine if heart rate and heart rate variability differ between depressed and nondepressed CAD patients.
Main Methods:
- Seventy-seven patients undergoing elective cardiac catheterization were assessed.
- Diagnostic psychiatric interviews were conducted.
- 24-hour ambulatory electrocardiography (ECG) was used to measure mean heart rate and heart rate variability.
Main Results:
- Depressed CAD patients exhibited significantly higher mean heart rates compared to nondepressed counterparts.
- This difference persisted regardless of age, smoking status, or beta-blocker use.
- Heart rate variability was lower in depressed patients, though not statistically significant.
Conclusions:
- Elevated heart rate in depressed CAD patients may indicate heightened sympathetic nervous system activity.
- This physiological change could contribute to the increased morbidity and mortality observed in this patient group.
- Further research is warranted to explore the therapeutic implications of managing sympathetic tone in depressed CAD patients.
Abstract:
Seventy-seven patients undergoing elective cardiac catheterization were administered a diagnostic psychiatric interview and their mean heart rates and heart rate variability were determined from the results of a 24 hr ambulatory ECG. The mean heart rate for depressed patients with coronary artery disease (CAD) was significantly higher than for nondepressed CAD patients, independent of the patient's age, smoking status, and beta blocker therapy. Heart rate variability was lower in depressed patients but did not achieve significance. With the exception of smoking, which was more common in depressed patients, there were no significant differences between the depressed and nondepressed patients on any other medical or demographic variable assessed. It is concluded that elevated heart rate may represent increased sympathetic tone in depressed CAD patients, and may help to explain the increased morbidity and mortality reported in these patients.