Depressed Coronary Artery Disease Patients Have Higher Risks

Female gender and more severe angina were considered predictors of depression.
Female gender and more severe angina were considered predictors of depression.

Depression is fairly common in patients with stable coronary artery disease (CAD) and is associated with increased risks for morbidity and mortality, according to new data presented at the 65th Annual American College of Cardiology Scientific Sessions & Expo in Chicago.

Natalie Szpakowski, MD and colleagues at the University of Toronto studied a cohort of 22 917 patients who were diagnosed with stable CAD based on index angiography performed between October 2008 and September 2013. To be included in the study, patients had to have arteries that were narrowed >70%, and specifically >50% in the left main coronary artery. Patients with previous diagnoses of depression or those who had ever had other cardiac events were excluded.

The main clinical outcomes were all-cause mortality and time to readmission for myocardial infarction (MI) and revascularization.

The incidence of depression was 18.8% with an increased risk of mortality (hazard ratio [HR]: 1.83; 95% confidence interval [CI]: 1.62-2.07). Patients were also at an increased risk for MI readmission (HR: 1.36; 95% CI: 1.10-1.67). During follow-up (average time: 3 years), patients with CAD who were depressed were 83% more likely to die from any cause compared with patients who were not depressed.

Female gender and more severe angina based on Canadian Cardiovascular Society class were considered predictors of depression (HR: 1.31; 95% CI: 1.23-1.39 and HR: 1.43; 95% CI: 1.16-1.76, respectively).

Dr Szpakowski spoke to the female gender being a predictor at a recent press conference. “This is consistent with the literature in that women are more prone to depression, whether it's due to sex hormones or social roles, we don't fully know,” she noted. “Other studies have also found that more severe chest pain has been linked to depression, and we know people with more medical illnesses are more susceptible to being depressed.”

Due to the design of the study, patients with “psychosocial distress” may have been included in addition to those patients with major depressive disorder. Dr Szpakowski cautioned that this “could have diluted the findings,” meaning that the effect of depression may be even stronger in patients with true depression.

“Based on these findings, there may be an opportunity to improve outcomes in people with CAD by screening for and treating mood disorders, but this needs to be further studied,” she concluded.

Sources

  1. Depression after heart disease diagnosis tied to heart attack, death [press release]. Chicago, IL: American College of Cardiology; March 23, 2016.
  2. Szpakowski N, Bennell M, Qui F, Kurdyak P, Wijeysundera H. Poster 1275M-05. Clinical consequences of a new diagnosis of major depressive disorder in patients with stable ischemic heart disease. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL. 
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