Depression and Heart Health in Women
Depression is bad enough for the heart - taking antidepressants may even be worse.
Study Title:Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women: Results From the Nurses' Health Study.
Objectives: We assessed the association between depression and sudden cardiac death (SCD) and cardiac events among individuals without baseline coronary heart disease (CHD).
Background: Depression is a risk factor for cardiac events and mortality among those with CHD, possibly from arrhythmia.
Methods: We studied depressive symptoms and a proxy variable for clinical depression consisting of severe symptoms and/or antidepressant medication use and their relationship to cardiac events in the Nurses’ Health Study. Questionnaires in 1992, 1996, and 2000 assessed symptoms with the Mental Health Index (MHI-5), and antidepressant use was assessed in 1996 and 2000. Primary end points included SCD, fatal CHD, and nonfatal myocardial infarction.
Results: Among 63,469 women without prior CHD/stroke in 1992, 7.9% had MHI-5 scores <53, previously found to predict clinical depression. Depressive symptoms were associated with CHD events, and the relationship was strongest for fatal CHD, where the association remained significant even after controlling for CHD risk factors (hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.11 to 2.00 for MHI-5 score <53). In models from 1996 onward, our proxy variable for clinical depression was most associated with SCD in multivariable models (HR: 2.33, 95% CI: 1.47 to 3.70), and this risk was primarily due to a specific relationship between antidepressant use and SCD (HR: 3.34, 95% CI: 2.03 to 5.50).
Conclusions: In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD. Although antidepressant use might be a marker of worse depression, its specific association with SCD merits further study.
From press release:
New data published in the March 17, 2009, issue of the Journal of the American College of Cardiology suggest 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).
Researchers 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.”
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. “It raises the question of whether this association may have something to do with the antidepressant drugs used to treat depression.”
Both Drs. Whang and Narayan stress that although the relationship between antidepressant medicines and SCD merits further investigation to determine whether antidepressant medications directly increase the risk for heart rhythm disorders, at present the benefits of appropriately prescribed antidepressants outweigh the risk of sudden cardiac death. There was no relationship between antidepressant use and fatal CHD or nonfatal heart attack.
“We can’t say antidepressant medications were the cause of higher risk of sudden cardiac death. It may well be that use of antidepressants is a marker for worse depression,” adds Dr. Whang. “Our data raise more questions about the mechanisms by which depression is associated with arrhythmia and cardiac death.”
Plausible explanations for the link between depression and SCD may include autonomic dysfunction, higher resting heart rates and reduced heart rate variability, according to Dr. Whang. Researchers also found an association with nonfatal MI, but this became borderline non-significant when adjusted for multiple other CHD risk factors.
Still, these study findings reinforce the need for patients with depression to be monitored closely for risk factors for coronary heart disease, since management of these risk factors can reduce the risk for mortality from coronary heart disease and sudden cardiac death.
Dr. Whang reports no conflict of interest.
William Whang, Laura D. Kubzansky, Ichiro Kawachi, Kathryn M. Rexrode, Candyce H. Kroenke, Robert J. Glynn, Hasan Garan, and Christine M. Albert. Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women: Results From the Nurses' Health Study. J Am Coll Cardiol 2009 March
Related Entries: Brain Inflammation Now Documented in Chronic Fatigue Syndrome
Brain Protective Effects of Proathocyanidins
Nutrient Highlight: Discover the Best Form of Folate
Lutein and Zeaxanthin Offset Gene Weaknesses that Cause Macular Degeneration
Lycopene Builds Its Anti-Prostate Cancer Case
Carotenes Improve the Quality of Semen
Vitamin B12 as Methylcobalamin Repairs Nerves & Lowers Pain
Folic Acid Activates Neural Stem Cells for Brain Rejuvenation
Chromium Improves Insulin Function & Reduces Binge Eating
How Fiber and Niacin Protect Against Colon Inflammation and Cancer
Berries Have Anti-Aging Impact on Immune System
Strawberries Reduce Cardiovascular Risk
Friendly Flora Improves Fatty Liver Disease
Flavonoid Intake Improves Cardio Health in At-Risk Men
Polyphenols and Essential Fatty Acids Reduce Cardio Risk in Overweight People
Vitamin C Reduces the Risk for Hemorrhagic Stroke
Testosterone Therapy Increases Heart Attack Risk
Magnesium Intake Linked to Lower Cardiovascular Inflammation
Q10 Boosts Energy, Nerves, Muscles & Metabolism
Coenzyme Q10 Remarkably Improves Circulation
Tyrosine Helps Maintain Mental Ability Under Stress
Green Tea Extract Lowers Blood Pressure, Cholesterol, Blood Sugar & Inflammation
Poor Flexibility is a Sign of Stiff Arteries
A Sluggish Lymph System Causes Snoring & Sleep Apnea
DHA is Vital to Cardiovascular Wellness
Magnesium Supplements Lower Blood Pressure, Prevent Calcification
Magnesium for the Prevention of Heart Disease
Pomegranate Protects HDL Cholesterol from Damage
Pomegranate Blocks Flu Replication
Tocotrienols: Twenty Years of Dazzling Cardiovascular and Cancer Research
Is Resveratrol the Fountain of Youth?
Grape Seed Extract Lowers Blood Pressure
Scientists Tout Resveratrol as a Primary Nutrient for Cardio Health
Leptin, Thyroid, and Weight Loss
Excess Appetite Causes Abdominal Fat
Low Energy? Detect Thyroid Related Fatigue
Curcumin Boosts AMPK Activation, Prevents Fatty Liver
Quercetin Activates Mitochondrial Biogenesis
Quercetin Guards Against Inflammation-Induced Bone Loss
Head Injuries Double or Triple the Risk of Early Death
Fatty Fish Consumption Lowers the Risk of Type 2 Diabetes by 33%
Flavonoids Continue to Show Potent Diabetes Prevention
Vitamin K2 Decreases Bone Loss in Postmenopausal Women
Cissus Quadrangularis Enhances Fracture Healing
Cissus Quadrangularis Reduces Exercise-Related Joint Pain
Nobiletin and Tangeretin Help Protect Against Bone Loss
Nobiletin and Tangeretin Inhibit Respiratory Virus
Oregano Oil Inhibits Biofilm Formation
Bromelain Helps Chronic Sinus Inflammation
Curcumin Demonstrates Potent Anti-Flu Properties
Quercetin Protects Brain and Body from Low Oxygen Stress
Ubiquinol Q10 Protects Against Magnified Tissue Injury
Ubiquinol Q10 Protects Eyes of Diabetic Patients
Limonene Promotes Healing of Digestive Lining
Magnesium Intake Reduces Mortality
Fiber is Vital for Cardio Health
Friendly Flora Boosts Weight Loss in Obese Women
Tocotrienols Help Correct Fatty Liver in Humans
Vitamin E Boosts Quality of Life for Alzheimer’s Patients
Astaxanthin Demonstrates Brain Protection & Rejuvenation
Top 10 Health Stories of 2013
Resveratrol’s Amazing Anti-Aging Effect on Circulation
Grape Seed Extract Normalizes Blood Pressure in Mild Hypertension Patients
Don’t Let Bacterial Infections Set Up Shop
Viral Replication Fueled by Sugar
Anti-Vitamin Propaganda Hits a Fever Pitch
Antacid Medications Cause Vitamin B12 Deficiency, Speed Aging
Men Should Take Folic Acid Prior to Conception to Prevent Birth Defects
Exercise Potently Reduces the Risk for Diseases of Aging
Fisetin Demonstrates Potent Bone Protection Properties
Green Tea (EGCG) Improves Body Weight and Autoimmune Arthritis
Low Midlife Iron Contributes to Declining Cognitive Function in Women
DHA Reduces Inflammation in Brains of Alzheimer’s Patients
Low Magnesium Linked to Poor Vitamin D Status
Vitamin D Lowers Depression and Nerve Pain in Women with Type 2 Diabetes
Adequate Vitamin D is Needed to Prevent Brain Damage
Nutrition Makes Anti-Aging Possible: Secrets of Your Telomeres
Acetyl-L-Carnitine and Lipoic Acid Rejuvenate Stressed Mitochondria
Low DHA and EPA Linked to Major Depression and Anxiety
Higher Dose DHA and EPA Reduce Infection Toxins
DHA and EPA Help People with Dry Eye Syndrome
Tocotrienol E Supports Bone Health
Antioxidants and Magnesium Linked to Better Hearing
Bovine Lactoferrin Anti-Flu Properties
Olive Leaf Extract Improves Blood Sugar Metabolism
Bovine Colostrum’s Potent Immune-Support Activity
EPA and DHA Boost Mental Health Scores in Healthy Adults
DHA and EPA Boost Brain Function in Children with ADHD
Chlorella Reduces Red Blood Cell Damage Linked to Cognitive Decline
Aerobic Exercise Boosts Cognitive Function, Brain Structure & Cardiovascular Health
Aerobic Exercise During Pregnancy Boosts Baby’s Brain
How Fiber and Friendly Flora Help Digestive Immunity
Anti-Aging Properties of Astaxanthin
Tocotrienols Stabilize Mast Cells
Q10, Zinc, and Antioxidants Needed During the Flu
Ubiquinol Q10 Anti-Aging Properties
Magnesium Intake Improves Insulin Resistance
Limonene Boosts Metabolism, Lowers Inflammation & Stress
Alkylglycerols Boost Digestive Immunity
Most Popular News:
Connect with Wellness Resources: