Writing Committee for the ENRICHD Investigators C ARDIOVASCULAR DISEASE IS THE leading cause of death and a major cause of morbidity and disability in the United States, with an estimated 6 million people having symptomatic coronary heart disease (CHD). 1 Recent studies 2-7 have shown that depression and low perceived social support (LPSS) are associated with increased cardiac morbidity and mortality in CHD patients. In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depression is approximately 27%. 8-10 After an acute myocardial infarction (MI), depression is a risk factor for mortality independent of cardiac disease severity. 4,6 A recent randomized clinical trial found that the antidepressant sertraline hydrochloride was effective in treating recurrent depression in patients with either an acute MI or an episode of unstable angina. 11 However, no clinical trial has examined whether treating depression with counseling or antidepressants after an acute MI improves survival or reduces cardiac risk. The absence of social support is also a risk factor for cardiac morbidity and mortality in patients with CHD. 2,3,5,7 No clinical trial has tested the effects of increasing social support on clinical end points following acute MI, although

In a large health maintenance organization, a case-management system was considerably more effective than usual medical care for modification of coronary risk factors after myocardial infarction.

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