Depression and coronary heart disease: Association and implications for treatment
ABSTRACT
Growing evidence indicates that depression is an important primary and secondary risk factor for coronary heart disease (CHD). Depression is quite common among patients with CHD: prevalence estimates are 14% or higher, and an additional 20% of patients have subclinical or minor depression. This review summarizes evidence that depression is a risk factor for cardiac events in patients with established CHD, suggests potential mechanisms underlying the relationship between depression and adverse cardiac outcomes, and provides evidence for the efficacy of exercise in improving both depression and clinical outcomes in depressed patients with CHD.
CONCLUSIONS
Although depression has emerged as an important risk factor for CHD, there is no consensus on the optimal way to treat depression in patients with CHD. Interventions that are guided by an understanding of the mechanisms linking depression to CHD may prove to be most effective in improving both depression and physical health outcomes.
Exercise targets many of the mechanisms by which depression may be associated with increased risk, including autonomic nervous system activity, hypothalamic-pituitary-adrenal axis function, platelet activation, vascular function, and inflammation. Moreover, a growing body of evidence suggests that exercise is an effective treatment for depression that may be comparable in effect to antidepressant medication, at least in select subgroups (eg, patients who are receptive to exercise as a treatment for depression). The value of exercise training—not only for improving quality of life, but also for improving “biomarkers” of risk and other relevant health outcomes—is the focus of our current research efforts.
