Quick study: Probing links between depression, heart disease

THE QUESTIONS: Does depression contribute to calcium buildup in arteries—a condition that is associated with clinical heart disease—in older adults? And is depression's association with heart disease the same for men and women?

THE HISTORY: Depression has been linked to heart disease in older adults. A number of studies have measured depression after the occurrence of heart disease and found that patients have worse outcomes. Other studies have measured depression before the occurrence of heart disease, then followed up 20 years later and found a relationship as well.

THIS STUDY: Researchers examined depression in a large cross section of patients recruited from Kaiser Permanente. While disease causality cannot be implied from cross-sectional studies, this study found that higher rates of clinical depression were associated with the most advanced categories of clinical coronary disease, particularly in women. Researchers found no links between depression and calcium buildup.

WHO MAY BE AFFECTED: While this is an issue for both men and women at risk of heart disease, the study showed that the prevalence of depression in women who had a heart attack was double that of men who had suffered a heart attack.

WHY IT MATTERS: The study may be a wake-up call to the medical community to provide a quick, easy questionnaire to patients, particularly women, after heart attacks to determine whether they have depression.

CAVEATS: This study is a first step toward understanding the relationship between depression and heart disease, and it remains to be determined to what extent depression is a cause or an effect. Researchers now believe that the connection between depression and heart disease is related to events other than calcium buildup, such as sudden plaque rupture. Future studies examining biomarkers related to plaque rupture (for example, clotting and inflammatory factors) may provide more insight into the relationship of psychological factors and heart disease.

STANFORD CONNECTION: Stanford authors include first author Joan M. Fair, PhD, Mohammed Mahbouba, software developer, Linda Norton, MaryBeth Usinowicz and primary author Stephen P. Fortmann, MD, PhD.

PUBLIC AIRING: Poster presented at the March 2-5 Conference on Cardiovascular Disease Epidemiology and Prevention in Phoenix. —Tracie White