Depression: Links to Cardiovascular Disease

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Guest: Dr. John Freedy – Family Medicine

Host: Dr. Linda Austin.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. John Freedy who is Assistant Professor of Family Medicine and has a PhD in psychology and has served on our faculty in Psychiatry and Behavioral Sciences here at MUSC before becoming an MD. So that is an extra set of credentials, John.

Let’s talk today about a topic that is of special interest to you which is the relationship of depression and heart and vascular disease. How are those two illnesses connected?

Dr. John Freedy: The first thing to realize is that they are connected and we can talk about cause or effect. There have been studies looking at people who have had depression in their young adult life and following them over a period of time and controlling for other factors that we think of as risk for cardiovascular disease, things like hypertension, smoking, cholesterol, obesity, and if you control for all those other factors and they were depressed in their young adult life, they are more likely to have their first heart attack. So we know that there is something about being depressed that can put an individual at risk later for heart disease.

Now, once a person has established heart disease, we also know that they are more likely if they are depressed after, say, a heart attack to subsequently have complications including a subsequent heart attack as well, as complications leading to death.

Dr. Linda Austin: If somebody is depressed, is there any data to show that getting that depression treated will actually lower the risk of heart attack?

Dr. John Freedy: It is a question that people have been keenly interested in because of the relationship between depression and cardiovascular disease. There have been several well done studies and, disappointingly, it does not appear that treating the depression reduces subsequent heart attack or subsequent cardiovascular death. It does, however, improve quality of life and functionality. So there is a reason to treat the depression, certainly. We do not know the relationship between depression and risk for other diseases and mortality for other causes, so there are still some questions out there and reasons to treat the depression.

Dr. Linda Austin: So what do you think is going on that causes that association between depression and heart disease?

Dr. John Freedy: Well, there are two thoughts that people consider. One thought is that if you are depressed, you do not function as well in terms of your thinking, your coping, your functioning, so maybe you are less able to take good care of yourself. You are less compliant with medications. You are less likely to have medical follow-up. Maybe you do not eat as well. Maybe you do not exercise. Maybe you are more likely to smoke, have other negative health habits, these sorts of things. So that is one possibility that is considered.

The other possibility that is considered is that there is something biological going on within the person, an increase, for example, in stress hormones that may be, for example, pro-inflammatory. The importance of being pro-inflammatory would mean that you are more likely to form plaques. You are more likely to have plaques within important blood vessels that rupture and can cause a subsequent heart attack, for example. Or, if you already have vascular disease, you might be more likely to have a heart arrhythmia that could lead to problems with the heart’s function or even lead to a blood clot forming and going up to the brain and having a stroke.

So either of those reasons, being less compliant, less able to take care of yourself, or something biological that is pro-inflammatory or pro-arrhythmic going on are thoughts that we consider.

Dr. Linda Austin: So this


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