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Depression predicts heart attack occurrence
(March 2006)

Depression is a huge problem in the United States. At least 10 percent of men and 25 percent of women will suffer a major depression during their life times. A recent report from the 2004 National Survey on Drug Use and Health found that, in the past year, 9 percent of adolescents ages 12 to 17 years experienced at least one major depression episode. Depression is associated with greater drug and alcohol use and more cigarette smoking. It also has been associated with subsequent coronary heart disease and heart attacks. A Swedish study published in the American Journal of Preventive Medicine in December 2005 gives further credence to that association. Between 1987 and 2001, there were reported 44,826 cases of first hospitalization for depression in Sweden. Of those ages 25 to 64 years, 1,176 subsequently developed coronary heart disease and 716 had a heart attack. Compared to those not diagnosed with depression, there was a 26 percent increased risk of heart attack in depressed men and a 41 percent increased risk in women. This was particularly found in those ages 40 to 59 years at the time of heart attack occurrence (increased risk in men ages 40 to 49 years was 63 percent and in women ages 40 to 49 risk more than doubled). Interestingly, among those whose heart attack occurred after age 70, there was no increased risk among previously depressed persons.

Commentary: This is a reasonable study that is in accord with many other data. The mechanisms are not clear, but it is known that depression can change the inflammatory response and can increase blood clotting, both of which could promote heart attacks.

The study does have some obvious flaws.

- There is no information about the time interval between hospitalization for depression and heart attack occurrence.

- There is no information on cholesterol levels, blood pressure, and cigarette smoking. Obviously, the increased risk could relate increased cholesterol level, greater cigarette use, or higher blood pressure in depressed persons.

The lack of increased risk of heart attack among depressed persons in those 70 to 79 years of age at the time of heart attack may reflect the substantial possibility that those destined to have a heart attack as a consequence of depression experienced the heart attack before age 70.

The study focuses on depression severe enough to require hospitalization. That might be expected to skew the findings towards finding more resulting heart attacks than would be found if both hospitalized and non-hospitalized persons had been evaluated. On the other hand, those hospitalized for depression are likely to get the most extensive treatment and might, therefore, be at less risk for future heart attacks.

There are multiple studies showing that depressed persons, hospitalized or not, are at increased risk of heart attacks.

Sundquist, J., et al. Depression as a predictor of hospitalization due to coronary heart disease. American Journal of Preventive Medicine. Vol 29 (December) Pgs 428-433. 2005.

The main reason for reviewing this study is to emphasize that major depression (moderately severe to severe) has important health consequences. It is, therefore, critical to screen for depression and, if found, make sure it is treated appropriately. Most depression goes undetected and, even when diagnosed by health care providers, it is often inadequately treated.

Healthful Life recommends annual depression screening with a standard questionnaire starting at age 20.

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