CHICAGO — Behavioral mechanisms such as smoking and physical inactivity accounted for nearly 40% of the link between depressive symptoms and coronary heart disease in a cohort of participants in the REGARDS trial.
During a presentation at the American College of Cardiology’s 61st Scientific Sessions, Siqin Ye, MD, of Columbia University Medical Center, N.Y., noted that depressive symptoms are associated with increased morbidity and mortality in individuals with CHD, but that the role of behavioral risk factors in this relationship is not clear.
“There is very limited evidence that treating depression with antidepressants or therapy improves cardiac outcomes, and it may be that simply treating depression is not sufficient,” Ye said “More global strategies specifically targeting healthy behavior are needed in this high-risk population.”
The analysis included 4,676 patients with CHD at baseline. Researchers studied 30,239 REGARDS cohort participants. Depression was defined as a score of ≥4 on the Center for Epidemiologic Studies Depression Scale. The researchers created models to assess links between depressive symptoms and definite/probable MI or death. They then added disease-specific and behavioral risk factors to a model that included socio-demographic covariates and BMI.
There were 638 individuals with depressive symptoms at baseline. Mean follow-up was 3.5 years.
Events were observed in 19.6% participants with depressive symptoms and 16.3% participants without symptoms.
Researchers identified a link between depressive symptoms and a higher risk for events (HR=1.41; 95% CI, 1.15-1.72). However, this risk was attenuated after behavioral risk factors were entered into the model (HR=1.17; 95% CI, 0.96-1.43).
“Behavioral mechanisms accounted for 36.9% of the relationship between depressive symptoms and CHD events,” Ye said. The two behavioral factors which contributed most to the attenuation were smoking (–17.6%) and physical inactivity (–21.1%).
“We again confirmed that depression conveys increased risk for adverse cardiac outcomes in patients with CHD,” Ye told Cardiology Today. “We also showed that behavior such as smoking or physical inactivity explains a substantial part of that risk. For physicians taking care of these patients, it is very important to consider these issues and provide appropriate interventions such as smoking cessation counseling and cardiac rehabilitation, as the guidelines already recommend. Our findings suggest that these interventions may be especially important for patients who have both depression and CHD.” – by Rob Volansky
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Disclosure: The REGARDS study was supported by cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and Department of Health and Human Services. Dr. Ye was supported by an ACC/Merck Research Fellowship award and by National Institutional of Health Grant T32HL007854-16.
It is clear that our approach to the management of patients with CHD, adherence to behavioral modifications and compliance to medications are key predictors of subsequent outcomes. This study stresses the importance of screening and a multidisciplinary approach for these individuals, which is more likely to change the natural history of the disease.
– Joaquin E. Cigarroa, MD
Oregon Health & Science University