Depression and cardiac function in patients with stable coronary heart disease: findings from the Heart and Soul Study.
OBJECTIVE
To determine whether depression is associated with worse cardiac disease severity in patients with stable coronary heart disease (CHD). There is considerable evidence that depression is a risk factor for adverse cardiovascular events in patients with CHD. However, a frequent criticism of this literature is that the association between depression and adverse cardiovascular outcomes may be confounded by worse baseline cardiac disease severity in depressed patients.


METHODS
In a sample of 1020 outpatients with stable CHD, we examined the association between major depression (assessed using the Computerized National Institute of Mental Health Diagnostic Interview Schedule) with measures of cardiac disease severity, including systolic dysfunction, diastolic dysfunction, exercise-induced ischemia, and cardiac wall motion abnormalities. Cross-sectional univariate and multivariate models controlling for demographic and clinical variables were computed.


RESULTS
Of the 1020 participants, 224 (22%) had current (past month) major depression. After adjustment for age, major depression was not associated with systolic dysfunction, diastolic dysfunction, inducible ischemia, or cardiac wall motion abnormalities. Similarly, multivariate models revealed no significant relationship between major depression and cardiac disease severity.


CONCLUSIONS
Overall, we found little evidence that depression is associated with worse cardiac disease severity. This suggests that greater baseline cardiac disease severity is unlikely to be responsible for the increased risk of CHD events in depressed patients.
Lett
Heather
H
VA Palo Alto Health Care System, Palo Alto, California, USA.
Ali
Sadia
S
Whooley
Mary
M
D000368:Aged; D000704:Analysis of Variance; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003971:Diastole / Q000502:physiology; D025401:Echocardiography, Stress; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D012307:Risk Factors; D013223:Statistics as Topic; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology