Women with symptoms of depression have an increased risk of developing coronary heart disease (CHD), especially fatal CHD, according to findings from the Nurses’ Health Study.
The results, lead author Dr. William Whang and associates note, also suggest a specific association between antidepressant use and sudden cardiac death.
The Nurses’ Health Study, which has followed 121,700 female registered nurses since the mid-1970s, is one of the largest investigations into risk factors for major chronic diseases in women ever conducted.
Although depression does appear to have some independent effect on the risk of CHD, much of the association is due to other factors that often coexist with depression, the report suggests.
“A significant part of the heightened risk for cardiac events seems to be explained by the fact that CHD risk factors, such as high blood pressure, diabetes, elevated cholesterol, and smoking, were more common among women with more severe depressive symptoms,” Whang, from Columbia University Medical Center in New York, said in a statement.
The new study included 63,469 women who were evaluated for depressive symptoms in 1992, 1996, and 2000 using the Mental Health Index questionnaire. Antidepressant use in 1996 and 2000 was also evaluated. All of the women were free from heart disease and stroke in 1992.
Nearly 8 percent of women had mental health scores consistent with clinical depression, according to the report in the March 17th issue of the Journal of the American College of Cardiology.
Depressive symptoms were associated with heart disease, particularly fatal CHD. A low mental health score increased the risk by 49 percent, after the researchers also considered the possible effects of other CHD risk factors.
Further analysis showed that depressive symptoms more than doubled the odds of sudden cardiac death, an association largely due to antidepressant use. Antidepressant use increased the risk by 3.34-fold.
“Although antidepressant medication use might be a marker of worse depression, its specific association with elevated risk of sudden cardiac death merits further study,” the authors state.
In a related editorial, Dr. Sanjiv M. Narayan and Dr. Murray B. Stein, from the University of California, San Diego, agree that antidepressant use may simply be a marker for more severe depression, but caution that the findings are nonetheless “sufficiently sobering to warrant heightened clinical surveillance and to initiate studies to definitively address this relationship.”
SOURCE: Journal of the American College of Cardiology, March 17, 2009.