Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2007;9(1):9-17.
doi: 10.31887/DCNS.2007.9.1/ahglassman.

Depression and cardiovascular comorbidity

Alexander H Glassman  1
Affiliations
Review

Depression and cardiovascular comorbidity

Alexander H Glassman. Dialogues Clin Neurosci. 2007.

Abstract
in English, Spanish, French

Depression has long had a popular link to cardiovascular disease and death. However, only during the last 15 years has scientific evidence supporting this common wisdom been available. Beginning in the early 1990s, there began to accumulate community-based epidemiological evidence that medically healthy, depressed patients followed for long periods of time were at increased risk of both cardiovascular disease and cardiac death. In the mid-1990s, evidence appeared to indicate that depression following a heart attack increased the risk of death. It is now apparent that depression aggravates the course of multiple cardiovascular conditions. There are two major unanswered questions. One is whether treating depression will reduce the risk of cardiovascular disease and death. Here, preliminary, but not definitive, evidence suggests that the serotonin reuptake inhibitors may be useful. The other unanswered question regards the mechanisms that underlie this link between depression and cardiovascular disease. There is strong evidence linking platelet activation, autonomic activity and inflammatory markers to both depression and heart disease, but why these links exist is far less clear.

Popularmente la depresión se ha relacionado hace largo tiempo con la enfermedad cardiovascular y la muerte. Sin embargo, sólo durante los últimos quince años se ha contado con evidencia científica que respalde este conocimiento populan Al inicio de la década de los noventa se comenzó a acumular evidencia epidemiológica de estudios en la comunidad de pacientes depresivos, médicamente sanos, que fueron seguidos por largos períodos de tiempo en quienes se encontró un mayor riesgo tanto de enfermedad cardiovascular como de muertes por causa cardíaca. A mediados de los noventa, la evidencia pareció indicar que la depresión post ataque cardíaco aumentaba el riesgo de muerte. Hoy está claro que la depresión agrava el curso de diversas patologías cardiovasculares. Hay dos preguntas principales sin responder. Una es si acaso el tratar la depresión reducirá el riesgo de enfermedad cardiovascular y de muerte. Para esta pregunta la evidencia sugiere, preliminar pero no definitivamente, que los inhibidores de la recaptación de serotonina pueden ser útiles. La otra pregunta sin responder se refiere a los mecanismos que subyacen a la relación entre depresión y enfermedad vascular. Existe una poderosa evidencia que relaciona la activación plaquetaria, la actividad autonómica y los marcadores de la inflamación tanto con la depresión como con la enfermedad cardíaca, pero el porqué existen estas relaciones aun no se ha aclarado.

L'idée qu'il existe un lien entre dépression, maladie cardiovasculaire et décès est ancienne et populaire. Il a fallu néanmoins attendre ces 15 dernières années pour disposer d'arguments scientifiques confirmant ce bon sens commun. Au début des années 90, des preuves épidémiologiques basées sur la population générale ont commencé à s'accumuler en faveur de l'augmentation du risque conjoint de maladie cardiovasculaire et de décès cardiaque chez des patients déprimés, médicalement sains et suivis sur de longues périodes. Au milieu des années 90, il a été montré que la dépression après une crise cardiaque augmentait le risque de décès. Nous savons maintenant que la dépression aggrave l'évolution de nombreuses maladies cardiovasculaires. Deux questions majeures restent sans réponse : traiter la dépression réduira-t-il le risque de maladie cardiovasculaire et de décès? Les inhibiteurs de la recapture de la sérotonine semblent répondre positivement au premier abord, mais pas de façon définitive. L'autre question concerne les mécanismes qui sous-tendent ce lien entre dépression et maladie cardiovasculaire. Activation plaquettaire, activité autonome et marqueurs inflammatoires sont très certainement liés à la dépression et à la maladie cardiovasculaire mais pourquoi le sont-ils? Voilà qui est loin d'être compris.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Relative risk of coronary artery disease (CAD) in depressed patients; a meta-analysis of 10 studies. Adapted from ref 2: Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med. 2003;65:201-210. Copyright © Lippincott, Williams &Wilkins 2003.
Figure 2.
Figure 2.. Cumulative mortality in depressed and nondepressed patients following myocardial infarct (MI). Adapted from ref 12: Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993 20;270:1819-1825. Copyright © American Medical Association 1993
See this image and copyright information in PMC

References

    1. Kessler RC., Chiu WT., Dernier O., Merikangas KR., Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–627. - PMC - PubMed
    1. Wulsin LR., Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med. 2003;65:201–210. - PubMed
    1. Malzberg B. Mortality among patients with involution melancholia. Am J Psychiatry. 1937;93:1231–1238.
    1. Glassman AH., Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry. 1998;155:4–11. - PubMed
    1. Weeke A. Causes of death in manic-depressives. In: Schou MSE, ed. Prevention and Treatment of Affective Disorders. London, UK: Academic Press. 1979:289–299.

MeSH terms

LinkOut - more resources