AHA Includes Depression as Risk Factor for Cardiac Disease

Depression is common after acute coronary syndrome (ACS), according to a brief review by the authors featured as part of the current American Heart Association (AHA) Scientific Statement. It is encountered in approximately 20% of patients hospitalized for ACS, compared with a prevalence of approximately 4% in the general population. Depression not only reduces quality of life among these patients but also might increase the risk for recurrent cardiac disease. Potential mechanisms by which depression can increase cardiovascular risk include neuroendocrine dysfunction, enhanced platelet activity, and endothelial dysfunction, as well as lifestyle factors (sedentary behavior, smoking, etc) noted to be worse in the presence of depression.

Depression should join the ranks of obesity, diabetes, hypertension, and smoking as an official heart disease risk factor, according to an expert panel convened by the AHA (American Heart Association).

The recommendation is based on an extensive literature review examining the risks for depression conducted by the panel, which included Robert M. Carney, PhD, professor of psychiatry at the Washington University School of Medicine in St. Louis, Missouri.

The AHA Scientific Statement notes that the combined findings support the call to formally “elevate depression to the status of a risk factor” for adverse outcomes, such as all-cause and cardiac mortality, in patients who have ACS.

“It was very gratifying to see this recommendation at this time and know that the potential risks are appreciated,” Dr. Carney, who is also a member of the AHA Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing, told Medscape Medical News.

“We’re hoping that eventually we’ll be able to show that treating depression will improve survival and heart health. Although that story remains to be done, I’m happy we’ve come this far,” Dr. Carney added.

The Scientific Statement was published online February 24 in Circulation.

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