Depression and the risk of adverse outcomes at 5 years in patients with coronary heart disease

Abstract

Background Cardiovascular diseases are a public health concern worldwide, with high rates of morbidity and mortality. Depression is a frequent comorbidity in coronary heart disease (CHD). It can be caused by the experience of suffering from heart disease, but it can also influence the prognosis of the CHD. The prevalence of depression in patients with cardiovascular disease is twice as high as that in the general population. Aim Assess the influence of depression in the prognosis at 5 years in patients with CHD. Methods 145 patients diagnosed with CHD were recruited between September 2013 and June 2015. Depression was assessed based on the PHQ-9 results at the time of hospitalization and 3 months after discharged. Sociodemographic and clinical variables were collected. A 5-year follow-up was carried out to verify death, reinfarction or any adverse outcome. Results 20% of the study population had depression at hospital admission compared with 11% at 3 months. Depression at 3 months after discharged was a differentiating factor to present complications (42.6 months, CI 95% 27.3–57.9) compared with patients without depression (55 months, CI 95%, 50.9–59.1) (Log-Rank p = 0.034). In the unadjusted model, the risk of heart complications increased with patients that have comorbidities, such as diabetes (HR 2.78, 95% CI 1.21–6.3) or hypothyroidism (HR 2.5 95% CI 1.09–5.7). Also, patients with post-hospitalization depression at 3 months were 3 times (95% CI 1.023–8.8) more likely to have complications during the follow-up period than nondepressed patients. After risk factor adjustment, the HR for depression was 2.01 (95% CI 0.57–6.9). Findings Patients with depression at 3 months following the coronary event, presented complications sooner than those without depression.

Depression and associated factors among Brazilian adults: the 2019 national healthcare population-based study

“…Previous studies corroborate these findings, especially with regard to cardiovascular disease, which may also have a bidirectional association with depression [ 6 , 25 , 29 ]. Evidence from observational studies suggests that depression independently predicts incident coronary artery disease events, congestive heart failure and adverse outcomes among individuals with established cardiovascular disease [ 30 – 32 ].…”

The Role of Brain-Derived Neurotrophic Factor (BDNF) in Depression and Cardiovascular Disease: A Systematic Review

“…Specifically, patients with depression have a 1.5-fold higher risk of developing CVD than patients without depression [12]. The prevalence of CVD in patients with major depressive disorder has been estimated to be 9.9% (95% CI: 7.4-13.3), with the cardiovascular-related mortality rate being higher than that in non-depressed patients [13]. Conversely, several studies have shown a higher prevalence of major depression in patients with CVD [14]: Major depression or an increase in depressive symptoms affects 20-45% of patients with coronary artery disease [15] and 30-40% of patients with stroke [16][17][18].…”

Longitudinal trends in the prevalence and treatment of depression among adults with cardiovascular disease: An analysis of national health and nutrition examination survey 2009–2020

“…Previous studies have clearly suggested that patients with cardiovascular disease (CVD) experience increased risk for depression compared to the general population (15–20 vs. 5%), which makes them more vulnerable to physical limitations, low quality of life, recurrence, high mortality and high healthcare costs ( 18 , 19 ). There are multiple pathophysiological mechanisms that explain the association between depression and CVD that does not occur by chance, such as increased levels of inflammatory markers, impaired heart rate variability, and hypothalamic-pituitary-adrenal (HPA) axis dysfunction ( 10 , 20 ).…”