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Association of depression with reduced heart rate variability in coronary artery disease
R M Carney1, R D Saunders, K E Freedland
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Insights
Depression in coronary artery disease (CAD) patients is linked to lower heart rate (HR) variability. This reduced HR variability may contribute to the increased cardiac mortality and morbidity observed in these individuals.
Area of Science:
- Cardiology
- Psychiatry
- Medical Science
Background:
- Decreased heart rate (HR) variability is a known risk factor for mortality in cardiac patients.
- Clinical depression is associated with adverse outcomes in patients with coronary artery disease (CAD).
Purpose of the Study:
- To test the hypothesis that depressed patients with CAD exhibit decreased HR variability compared to nondepressed CAD patients.
Main Methods:
- Nineteen patients with documented CAD and depression were compared with nondepressed CAD patients.
- Patients underwent 24-hour Holter monitoring.
- Standard deviation of normal-to-normal intervals was used as the primary index of HR variability.
Main Results:
- Depressed CAD patients had significantly lower HR variability (90 +/- 35 ms) than nondepressed CAD patients (117 +/- 26 ms).
- This difference remained significant after adjusting for relevant covariates (p < or = 0.01).
Conclusions:
- Decreased HR variability is evident in depressed patients with CAD.
- Reduced HR variability may be a contributing factor to the elevated risk of cardiac mortality and morbidity in this population.
Abstract:
Decreased heart rate (HR) variability is an independent risk factor for mortality in cardiac populations. Clinical depression has also been associated with adverse outcomes in patients with coronary artery disease (CAD). This study tests the hypothesis that depressed patients with CAD have decreased HR variability compared with nondepressed CAD patients. Nineteen patients with angiographically documented CAD and either major or minor depression were compared with a sample of nondepressed CAD patients according to age, sex, and smoking status. All patients underwent 24-hour Holter monitoring, and the standard deviation of all normal-to-normal intervals was used as the primary index of HR variability. HR variability was significantly lower in depressed than nondepressed patients (90 +/- 35 vs 117 +/- 26 ms; p < or = 0.01), even after adjusting for relevant covariates. Thus, decreased HR variability may help explain the increased risk for cardiac mortality and morbidity in depressed CAD patients.