Objectives The primary focus of this study was to examine associations between depressive symptoms and mental stress induced myocardial ischemia (MSIMI) in patients with coronary heart disease (CHD). Methods Adult patients with documented CHD were recruited for baseline mental stress and exercise stress screening testing as a part of the enrollment process of the REMIT trial. Patients were administered the Beck Depression Inventory II (BDI-II) and the Center for Epidemiologic Studies Depression Scale (CESD). Following a 24-48-hour Beta-blocker withdrawal, consented patients completed three mental stress tests followed by a treadmill exercise test. Ischemia was defined as 1) any development or worsening of any wall motion abnormality (WMA), 2) reduction of left ventricular ejection fraction (LVEF) ≥ 8% by transthoracic echocardiography, and/or ischemic ST-segment change by electrocardiography during stress testing. MSIMI was considered present when ischemia occurred in at least one mental test. Data were analyzed using logistic regression adjusting for age, gender, and resting left ventricular ejection fraction. Results One hundred twenty five (44.2 %) of 283 patients were found to have MSIMI and 93 (32.9%) had ESIMI. Unadjusted analysis showed that BDI-II scores were positively associated with the probability of MSIMI (OR = .1.30: 95% CI 1.06 – 1.60, p = .013) and number of MSIMI positive tasks (all p < .005). These associations were still significant after adjustment for covariates (ps ≤ .05). Conclusions In CHD patients, depressive symptoms were associated with a higher probability of MSIMI. These observations may enhance our understanding of the mechanisms contributing to the association of depressive symptoms to future cardiovascular events.

Background Major Depressive Disorder (MDD) and Chronic Heart Failure (CHF) have in common heightening states of inflammation, manifested by elevated inflammation markers such as C-reactive protein (CRP). This study compared inflammatory biomarker profiles in CHF patients with MDD to those without MDD. Methods The study recruited patients admitted to inpatient care for acute heart failure exacerbations, after psychiatric diagnostic interview. Patients with Beck Depression Inventory (BDI) scores < 10 and with no prior history of depression served as the non-depressed reference group (n = 25). MDD severity was defined as: Mild (BDI 10–15; n = 48); Moderate (BDI 16–23; n = 51); and Severe (BDI ≥ 24; n = 33). A Bio-Plex assay measured 18 inflammation markers. Ordinal logistic models were used to examine the association of MDD severity and biomarker levels. Results Adjusting for age, sex, statin use, BMI, LVEF, tobacco use, and NHYA class the MDD overall group variable was significantly associated with elevated interleukin (IL) −2 (p = .019), IL-4 (p = .020), IL-6 (p = .026),, interferon (INF)-γ (p = .010), monocyte chemoattractant protein (MCP-1) (p = .002), macrophage inflammatory protein (MIP-1β) (p = .003) and tumor necrosis factor (TNF)-α (p = .004). MDD severity subgroups had a greater probability of elevated IL-6, IL-8, IFN-γ, MCP-1, MIP-1β, and TNF-α compared to none-depressed group. The non-depressed group had greater probability of elevated IL-17 (p < 0.001) and IL-1β (p < 0.01). Conclusions MDD in CHF patients was associated with altered inflammation marker levels compared to CHF patients who had no depression. Whether effective depression treatment will normalize the altered inflammation marker levels requires further study.