Treatment of depression reduces cardiovascular risk

Patients who manage their depression through psychological therapy have a reduced risk of cardiovascular disease. This is the result of a large cohort study conducted in the UK. “Those whose symptoms of depression improved after therapy were 10% to 15% less likely to experience a cardiovascular event than those who did not,” the authors reported in European Heart Journal.

“There is an assumption, and even some indications, that treating depression might help protect against cardiovascular disease, but there is no conclusive evidence,” Heike Spaderna, PhD, professor of health psychology with emphasis in prevention and rehabilitation at the University of Trier, Trier, Germany, he said Medscape Medical News. “Of course, this retrospective study is also not proof of a causal relationship, but it is the first large-scale study to offer plausible evidence that this could be the case.”

Higher cardiovascular risk

Depression and cardiovascular disease are both widespread; therefore, it is possible for them to occur independently of each other. But the study data show that there is an interaction between the diseases. Cardiovascular disease contributes to depression and depression contributes to cardiovascular disease.

“The risk of cardiovascular disease is about 72 percent higher among people with major depressive disorder,” said lead author Cline El Baou, PhD, research assistant at University College London, London, UK. Medscape. “Our study suggests that the positive outcomes of evidence-based psychological interventions may extend beyond psychological health and have long-term physical health benefits, particularly for people younger than 60,” he added.

Seven-year follow-up

El Baou and his research team analyzed data from 636,955 adults who had received a course of psychotherapy (eg, cognitive behavioral therapy) for depression and were initially free of cardiovascular disease. The median age of these adults was 55, and two-thirds were female.

Improvement in symptoms of depression was measured as a reduction (6 points) in Patient Health Questionnaire-9 (PHQ-9) score without a deterioration in anxiety symptoms. This last criterion was intended to avoid that the therapy was considered successful if an improvement in depression coincided with a worsening of anxiety. Patient follow-up began 1 year after the last therapy session and continued for a median of 3.1 years, up to a maximum of 7 years.

Reduction of cardiovascular risk

Symptoms of depression improved in 59% of patients. Cardiovascular events were experienced by 49,803 study subjects and 14,125 died. Improved depression was associated with a 12% reduction in the risk of cardiovascular disease.

The risk of coronary heart disease (CHD) was 11% lower and the risk of stroke was 12% lower. All-cause mortality was 19% lower in patients with improved symptoms than in those whose psychotherapy had been unsuccessful.

In the analyses, the researchers considered variables such as age, ethnicity, gender, socioeconomic status, and other health care restrictions that could have influenced the associations.

Lifestyle, inflammatory processes

The study does not show the ways in which improvement in depression may have led to a reduction in cardiovascular risk. However, Spaderna offered two possibilities. “One mechanism could be that as depression improves, the patient’s lifestyle also improves. This is particularly true of physical activity. Both the association with depression and the protective effect on cardiovascular health are well demonstrated here” .

On the other hand, there is also the theory that depression encourages inflammatory processes in the body, including in the blood vessel walls. This can also affect cardiovascular health, Spaderna added.

younger subjects

El Baou and his coauthors also reported that the associations between improvement in depression and cardiovascular disease risk were pronounced in people aged 45 to 60. For this group, improvement in depression was associated with a 15% decrease in cardiovascular disease. In patients older than 60, there was only a 6% decrease.

Also, compared to all-cause mortality, people aged 45 to 60 benefited the most from a reduction in symptoms of depression. Their mortality risk was reduced by 22%. This reduction was only 15% in adults over 60.

“Our findings are consistent with previous research in this one [they show that] cardiovascular risk reduction interventions in general may be less effective in the elderly,” El Baou commented.

“Older adults may find it more difficult to lead more active lives, even if their depression has improved,” Spaderna said. But it would still be worth it. “Even in older adults, behavioral changes can have a positive effect on health and life expectancy.”

However, all-cause mortality could also play a role in the elderly. “Older people often have other conditions, such as high blood pressure or diabetes, that could affect cardiovascular risk. In this case, improving depression may not have any dramatic effect on cardiovascular health,” Spaderna added.

Access to psychotherapy

The authors admitted that the study cannot conclusively prove that the improvement in depression led to a reduction in cardiovascular disease. Lifestyle factors such as smoking and lack of exercise, for which no data were collected, may also have influenced the results.

However, El Baou is convinced that “it is extremely important to facilitate access to psychotherapists to promote mental and physical health”. This is especially true for communities that have difficulty accessing psychotherapeutic care and are simultaneously at high risk of cardiovascular disease.

“It is regrettable that many patients in Germany find it extremely difficult to find therapy,” Spaderna said. “This needs to be resolved urgently.” People also need to be made more aware that mental illnesses such as depression should be treated at an early stage, according to the psychologist. “The correlations between depression and cardiovascular disease are not yet sufficiently known,” she said.

This article has been translated from the German edition of Medscape.

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