Depression after heart disease 'raises heart failure risk

Washington, Apr 14 : Heart patients who become depressed are at greater risk for heart failure (HF), a condition in which the heart can't pump enough blood throughout the body, says a new study.

The study published in the April 21, 2009, issue of the Journal of the American College of Cardiology, is the first to investigate the influence of depression after heart disease on the likelihood of developing HF.

The research also found that taking antidepressant medications to ease depressive symptoms did not appear to mitigate this risk.

"Our data suggest that depression is an important and emerging risk factor for heart failure among patients with coronary heart disease," said Heidi May, Ph.D., M.S.P.H., epidemiologist, Intermountain Medical Center, Murray, Utah.

"Interestingly, when we stratified patients with depression by whether they received antidepressant medication or not, the incidence of heart failure didn't change. This finding may indicate that antidepressants may not be able to alter the physical or behavioral risks associated with depression and heart failure, despite a potential improvement in depressive symptoms," the expert added.

To reach the conclusion, patients (n = 13,708) without a diagnosis of HF and depression and who were not prescribed antidepressant medication at the time of CAD diagnosis were studied.

Of these, one out of 10 (n=1,377) was later diagnosed with depression. Data reveal that a depression diagnosis following CAD was associated with a 2-fold increased risk for the incidence of HF. This risk remained, but was slightly lower after adjusting for other cardiovascular risk factors (e.g., diabetes, hypertension, age). The incidence of HF among patients who were not depressed after being diagnosed with coronary artery disease (CAD) was 3.6 per 100 compared with 16.4 per 100 for those with a post-CAD depression diagnosis. The increase in the risk of a HF diagnosis was evident at the start of follow-up for those with a diagnosis of depression post-CAD.

"Our findings indicate that it may be important for clinicians to keep in mind that although a patient's depressive symptoms may improve, the risk for harmful cardiovascular outcomes related to depression might not," said May.

"Patients need to be carefully screened for depression so that interventions that alter some of the risk associated with depression can be used and the related risk of heart failure and other cardiovascular events can be diminished," the expert added.