Depression and Cardiovascular Disease

Abstract

For every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart. — William Harvey In 1628, William Harvey defined the circulatory system as we know it and proposed a link between the mind and the heart. This potential association received little attention for >300 years, until Frasure-Smith and colleagues1 published a study demonstrating that patients who are depressed at the time of an acute myocardial infarction (MI) have markedly elevated mortality as compared with patients who are not depressed. Since then, >100 studies have investigated this relationship, providing evidence that depression is prevalent (≈20% to 35%) in populations with cardiovascular disease, is predictive of developing cardiovascular disease, and is predictive of adverse outcomes among patients with existing cardiac disease.2,3 Depression, however, remains largely off the radar screen of cardiac care, in large part because of confusion about the nature of the association between depression and cardiovascular disease and the role of cardiovascular clinicians with regard to depressed patients. See p 271 In this issue of Circulation , Mallik et al4 add to our understanding of the relationship between depression and outcome in cardiac patients. Prospectively evaluating 963 coronary artery bypass graft (CABG) surgery patients, they found that 25% had substantial perioperative depressive symptoms. A graded, inverse relationship was noted between the severity of perioperative depressive symptoms and improvement in physical functional status 1 year after surgery. Patients with moderate to severe depressive symptoms were one third less likely to experience improvement in physical function after the operation, even after adjustment for >20 clinical variables. In other words, perioperative depressive symptoms appear to diminish the functional benefits of CABG surgery. The study by Mallik et al is an important contribution …