A new study points out that relatively healthy women with severe depression are at increased risk of cardiac events, including sudden cardiac death (SCD) and fatal coronary heart disease (CHD).
In the study, boffins found that much of the relationship between depressive symptoms and cardiac events was mediated by cardiovascular disease risk factors, such as high blood pressure, high cholesterol and smoking.
"It's important for women with depression to be aware of the possible association between depression and heart disease, and work with their health care providers to manage their risk for coronary heart disease," says William Whang, M.D., M.S., Division of Cardiology, Columbia University Medical Center, and lead investigator of the study.
"A significant part of the heightened risk for cardiac events seems to be explained by the fact that coronary heart disease risk factors such as high blood pressure, diabetes, elevated cholesterol, and smoking were more common among women with more severe depressive symptoms," the expert added.
To reach the conclusion, Dr. Whang and his colleagues prospectively studied 63,469 women from the Nurses Health Study who had no evidence of prior heart disease or stroke during follow-up between 1992 and 2004.
Self-reported symptoms of depression and use of antidepressant medication were used as measures of depression. To best identify those with clinical depression, researchers specifically examined women with the most severe symptoms defined by a validated 5-point mental health index score of less than 53 or regular antidepressant use.
The study found that women with more severe depressive symptoms or those who reported taking antidepressants were at higher risk for SCD and fatal CHD. In particular, women with clinical depression were more than twice as likely to experience sudden cardiac death.
Surprisingly, this risk was associated more strongly with antidepressant use than with depressive symptoms.
"These data indicate the link between depression and serious heart rhythm problems may be more complex than previously thought," says Sanjiv M. Narayan, M.D., F.A.C.C., University of California, San Diego, who co-authored the accompanying editorial with colleague, Murray Stein, M.D.