TUESDAY, Nov. 25, 2008 (Health.com) — It’s long been known that heart patients who are depressed are at greater risk of heart attack, stroke, and death than their happier peers, and now a new study sheds light on the reasons why.
The risk seems to be due to a patient’s behavior, rather than some mysterious biological factor or other problem, as some have theorized. Depressed people who have heart disease are more likely to smoke, less likely to take their medicine, and—the biggest problem—are less likely to exercise than nondepressed heart patients, according to the report in the Journal of the American Medical Association.
“The good news for patients is that it’s all about behavior,” says Mary A. Whooley, MD, of the Veterans Affairs Medical Center in San Francisco. Dr. Whooley was the lead researcher on the study, which followed 1,017 people with stable heart disease for nearly five years.
“That means that the link is modifiable and there’s something they can do about it,” she says.
The bad news? It’s all about behavior. “It’s so hard for people to change their behavior, and especially for depressed patients because they have so much less motivation to take care of themselves,” Dr. Whooley explains.
And it seems to be a vicious cycle. People who are depressed are more likely to develop heart disease in the first place, and people who have a heart attack are (not surprisingly) at risk for depression. Depression can also hamper recovery from heart surgery or heart failure.
Researchers have proposed numerous factors to explain the complex interplay between mood, stress, and cardiovascular health: Examples include behavior and biological factors such as inflammation; some experts even think that antidepressants are bad for the heart.
To dig deeper, Dr. Whooley and her team looked at people—mostly older men—with confirmed, stable heart disease, and assessed various measures of heart disease severity as well as hormones, inflammation markers, and even levels of omega-3 fatty acids.
“We spent a lot of time and effort and money measuring all sorts of fancy biomarkers,” Dr. Whooley says. “We thought for sure one of those was going to explain the link. We were really surprised that it was such a simple answer.”
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