Heart Disease and Depression: A Two Way Street

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Heart Disease and Depression: A Two Way Street
The heart is the seat of emotion. It is where we experience deep feelings, sincerity, passion and love. It is also where we feel depression, hostility, anxiety, and panic. This complex, vital, emotional organ is at the seat of a powerful connection between emotion, i.e. depression and cardiovascular diseases. Depression is an illness that affects that heart and is a powerful risk and predictor for heart disease. This is a message for all who are at risk, have heart disease or depression.

The Heart’s Own Nervous System

The heart begins to beat in the womb before the brain is formed. It is able to do this because the heart has its’ own internal nervous system. In 1991, J Andrew Armour, a pioneer in the field of neurocardiology, introduced the concept of a functional heart brain that has vastly broadened the understanding of the heart’s nervous system. He established that the heart is a sensory organ with its own highly sophisticated information encoding and processing center. In his e-book Neurocardiology-Anatomical and Functional Insights he describes how the heart’s own internal nervous system can process information and make decisions independent of the central nervous system and clearly it is a two way street between the brain and the heart.

This discovery has contributed to the global studying of the connection between heart disease and depression and other phenomena. Multiple studies have confirmed the elevated presence of depression and heart disease existing together or co-morbidity. This is a two-way street, i.e. major depression is linked with the development of heart disease and heart disease is linked with major depression. The disease affects multiple complex systems throughout the body involving the brain and autonomic nervous systems, the endocrine system, the immune system, and the vascular and blood systems.

Heart Disease and Depression Links and Risk

Heart disease is traditionally associated with the risk factors of cholesterol problems, smoking, hypertension, obesity, and diabetes, but as you will see, there is far more to the development of heart disease. The link between depression and heart disease has been found in heart failure, ischemic disease/heart attacks, high blood pressure, and heart rhythm abnormalities. Understanding that depression and heart disease is bi-directional is of major importance given the worldwide prevalence of depression and heart disease. The link between depression and heart disease is independent of the traditional risk factors, enough to the point that scientists agree that the greater the difficulty with depression the greater the risk of heart disease and vice versa.

Depression is a neurological illness due to inflammation. It is not just a bad mood or bad attitude. There are a number of inflammatory processes and signals that occur with depression and a general loss of balance between the heart, endocrine, immune system, and nervous system. High levels exist of pro-inflammatory cytokines (TNF-a, IL1, IL6) and other immune chemicals, along with platelets in a state of increased coagulation, i.e. sticky blood. These imbalances can lead to some profound risks and can be measured thru blood tests. Here are some startling facts that show how devastating this connection can be.

  • Twenty to fifty percent of patients who die because of a heart attack experienced an episode of depression prior to the event.

  • Individuals with depression are at a greater risk of death from heart related disorders for up to 10 years after the diagnosis of heart disease as compared to individuals without a depression history.

  • A significant predictor of death in patients at 6 and 18 months after a heart attack occurred in patients who had major depression independent of other risk factors.

  • The risk is higher for patients with major depression as opposed to minor depression.

Other Risk Factors

A different study looked at Beck scores and C-Reactive Protein (CRP) levels and risk of major cardiac problems. The researchers investigated the impact and prognosis of depression and the inflammatory marker CRP in men and women two months after a heart attack and followed them over the next two years. Researchers found that a score of 14 or more on the Beck Depression Inventory and a CRP lab level of 2.0 or greater predicted a much higher risk of a major adverse cardiac event (heart attack/death). The women in this study did not experience the same level of risk as men.

The Beck Depression Inventory is a widely available standard questionnaire used to measure symptoms of depression. It is readily found online or through most health care professionals. CRP is a blood test that is widely available through all commercial labs and your health care providers. A score of 14-19 on a Beck Depression Inventory is mild depression; a score of 0-13 indicates no to minimal depression. Severe depression scores are range from 29-64. A CRP score of 1.0-3.0 mg/L is considered an average risk of heart disease. Think through these results again. The researchers found that a Beck score of 14 (borderline mild) and an average CRP score of 2 was a good indicator of serious risk of a major cardiac problem in two years. These types of scores are considered within normal limits and usually not given any further thought. If this risk predictor holds true, there must be a much tighter viewing of results and a more aggressive approach to prevention and support.

There are several other blood tests that are used to measure risk for heart disease and inflammation. Some of them may be used to help evaluate inflammation elsewhere. A recent meta-analysis study extensively reviewed multiple studies and determined that these lab tests were the most valuable in measuring the risk of heart disease. They are listed in order of importance. They included C-Reactive Protein, fibrinogen, cholesterol, apolipoprotein B, the apolipoprotein A/apolipoprotein B ratio, high density lipoprotein, and vitamin D. Other markers used included cardiac troponins I and T, serum creatinine, cystatin C, and uric acid which are not always used in a clinical setting. Fibrinogen and uric acid levels were strong risk markers of stroke. Just how many physicians seeing patients with depression and heart disease use all of these markers? What about the unmentioned lab marker of homocysteine levels that is intimately involved with depression, heart disease and methylation? It is common practice even with cardiologists to use only the cholesterol panel and maybe CRP for labs for monitoring patients’ health, but clearly not a thorough approach.

BDNF, Heart, and Depression

Two studies published just days apart in January 2015 showed that low levels of BDNF (brain-derived neurotrophic factor) was an independent risk factor for cardiac events. Both showed that a low BDNF level is a prognostic indicator in heart failure and cardiac death. BDNF is the brain repair molecule that helps keep the brain healthy and promotes new nerve connections. Researchers are trying to develop therapeutic strategies to enhance BDNF function in the brain. Scientists know that BDNF is a bridge between inflammation and brain health. This may be a powerful link in the heart-brain connection given the heart’s own nervous system. Could it be that the heart’s own internal nervous system uses the same BDNF to repair just like the brain does? Should this lab value be included with the others mentioned above?

It will take considerable time to understand details of the intimate phenomenal web of connection and interplay between the brain and the heart. For now, it is vital to understand that heart disease and depression are related. It is a serious life threatening risk to ignore this connection. They are related with higher levels of inflammation with multiple markers and low levels of BDNF. Traditional risk factors do play a role, but research is showing us that the picture is far more complicated than cholesterol numbers.

Support for the Brain and Heart

We know that research shows powerful support for pine nut oil reducing sticky platelets. Blueberries, fish oil, flavonoids like tangeretin and nobiletin found in citrus peel, pantethine, curcumin, and proanthocyanidins or grape seed extract help support healthy BDNF production. These same nutrients also help reduce inflammation of many types. Exercise also helps increase BDNF production. Simply increasing omega 3 fats from fish or taking a fish oil supplement provides powerful brain and cardiac protection and is helpful in reducing inflammatory markers. HeartMath and other stress meditation tools help balance the stress between the heart and the brain and may be used together with nutrition and exercise. The empowerment comes though in recognizing this link between depression and heart disease and doing something about it. The mentality and attitude towards depression is often to hide it or to just “pull oneself up by the bootstraps” and just get over it. Don’t ignore this connection or the individual diseases. Both are devastating. Be proactive and get the help that you or your loved one needs today!

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