Low Heart Rate Variability and the Effect of Depression on Post–Myocardial Infarction Mortality

Carney, Robert M.; Blumenthal, James A.; Freedland, Kenneth E.; Stein, Phyllis K.; Howells, William B.; Berkman, Lisa F.; Watkins, Lana L.; Czajkowski, Susan M.; Hayano, Junichiro; Domitrovich, Peter P.; Jaffe, Allan S.

doi:10.1001/archinte.165.13.1486

Cited by 234 publications

(156 citation statements)

References 36 publications

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“…These findings are in contrast to our previously reported stress findings in the laboratory, which indicated HRV and cortisol differences , and to other laboratory investigations (e.g., Agelink et al, 2002;Carney et al, 2005;Carney et al, 2001). Recent results from the Heart and Soul study (Gehi, Mangano, Pipkin, Browner, & Whooley, 2005) support our HRV findings: In a cross-sectional design with 873 CVD patients (195 depressed), the authors did not find a relationship between depression and time-or frequency-domain measures of HRV that were measured by 24-hour ambulatory electrocardiography.…”

Section: Discussioncontrasting

confidence: 99%

“…Several studies have reported basal hypercortisolism (e.g., Gotthardt et al, 1995;Plotsky, Owens, & Nemeroff, 1998), hypercortisolism in response to stress (for a review, see Burke, Davis, Otte, & Mohr, 2005), or elevated cortisol levels after awakening in depression (e.g., Bhagwagar, Hafizi, & Cowen, 2005). A variety of studies have suggested that depressed subjects have less heart rate variability (HRV) than nondepressed controls (e.g., Agelink, Boz, Ullrich, & Andrich, 2002;Carney et al, 2005;Carney et al, 2001), even when controlled for potential confounds such as age, sex, and smoking, suggesting autonomic dysregulation. …”

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confidence: 99%

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Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Conrad

Wilhelm

Roth

et al. 2008

Journal of Psychiatric Research

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Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamicpituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (≥55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30 min, 12:00, 17:00, and 21:00 hours. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed patients at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals. KeywordsCardiovascular Disease; Cortisol; Depression; Heart Rate Variability Depression has a major impact on mortality, morbidity, and functional recovery in patients with cardiovascular disease (CVD) (Carney, Freedland, & Sheps, 2004). Several mechanisms have been proposed to explain how depression might increase CVD risk, including Corresponding Author: Frank H. Wilhelm, Ph.D.; Tel.: ++41-61-267 0593; Fax: ++41-61-267 0659; E-mail: frank.wilhelm@unibas.ch; Address: Institute for Psychology, University of Basel, Missionsstrasse 60/62, CH-4055 Basel, Switzerland. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Musselman, Evans, & Nemeroff, 1998). Abnormal HPA-axis function may contribute to CVD risk through a variety of related risk factors, including hypertension, high lipids, insulin resistance, and abdominal obesity, together constituting the metabolic syndrome (Brown, Varghese, & McEwen, 2004). Several stu...

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Conrad

Wilhelm

Roth

et al. 2008

Journal of Psychiatric Research

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“…A variety of potential mechanisms have been proposed, including changes in platelet aggregation, changes in autonomic function (37,38), neurohormonal alterations (39), and increased endothelial activation (40,41). Few studies have been performed among peritoneal dialysis patients (10).…”

Section: Discussionmentioning

confidence: 99%

Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease

Boulware¹,

Liu

Fink

et al. 2006

Clinical Journal of the American Society of Nephrology

169

180

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Temporal relationships among depression, medical comorbidity, and death or cardiovascular disease (CVD) events are complex. Clarifying temporal relationships may enhance current insight regarding the nature of the association of depression with poor outcomes. The temporal relation of depression symptoms (DS; score <52 on five-item Mental Health Index) assessed at 6-mo intervals for 2 yr to CVD event, all-cause death, cardiovascular disease deaths, and non-cardiovascular disease deaths was studied in 917 incident dialysis patients. Cox regression models were used to assess whether the proximity of DS measurement and DS duration would change observed associations between DS and events. Whether increasing medical comorbidity was associated with worsening DS also was assessed. In time-varying models, DS were strongly associated with all-cause deaths, cardiovascular disease deaths, and CVD events (adjusted relative hazard [95% confidence interval]: 2.22 [1.36 to 3.60], 3.27 [1.57 to 6.81], and 1.68 [1.05 to 2.69], respectively). Persistent and current DS were associated with greater risks for all-cause death. Incorporating a 6-mo time lag between DS and outcomes attenuated risks for all-cause death, non-cardiovascular disease deaths, and CVD events. In a subgroup analysis, patients with worsening medical comorbidity (n ‫؍‬ 32) during the first year of follow-up experienced a 2.42-point greater decline in mental health scores at 2 yr of follow-up compared with patients with no worsening in medical comorbidity (n ‫؍‬ 123), but findings were not statistically significant. DS are strongly related to death and CVD events, with persistent/current DS most strongly associated with poor outcomes. Attenuated risks from time-lag analyses indicate a partial role for reverse causality, suggesting that medical comorbidity may precede DS.

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“…In general, high total HRV indicates good dynamic balance between the sympathetic and parasympathetic system, whereas low total HRV suggests that the sympathetic system dominates. Low HRV is linked to poor health and wellbeing outcomes (Carney et al 2005;Thayer et al, 2010). Further, sympathetic mediators, such as threat, appear to exert their effects quickly and are reflected in the low frequency power of the HRV spectrum (Pomeranz et al, 1985).…”

Section: Sympathetic-parasympathetic Balancementioning

confidence: 99%

Joy and Calm: How an Evolutionary Functional Model of Affect Regulation Informs Positive Emotions in Nature

Richardson

McEwan

Maratos

et al. 2016

Evolutionary Psychological Science

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Low Heart Rate Variability and the Effect of Depression on Post–Myocardial Infarction Mortality

Cited by 234 publications

References 36 publications

Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease

Joy and Calm: How an Evolutionary Functional Model of Affect Regulation Informs Positive Emotions in Nature

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