Depression, Anger and Hostility Markers for CVD

Two studies published in the March 17 edition of the Journal of the American College of Cardiology conclude that depression, anger, and hostility may be red flags of heightened heart disease risk, even if you don't have heart disease right now.

The studies noted that sudden cardiac death may be more than twice as common among women with symptoms of major depression than women who aren't depressed. This finding comes from a study of more than 63,000 U.S. female nurses followed from 1992 to 2004. The nurses had no history of heart disease when the study started. The study also linked sudden cardiac death to antidepressant use, but it's not clear if that's related to the drugs or the depression.

It was also shown that chronically angry or hostile adults with no history of heart disease may be 19% more likely than their peers to develop heart disease are 24% more likely than other heart disease patients to have a poor prognosis. These findings came from reviewers who pooled data from 44 studies conducted in America, Europe, Asia, and Australia between 1983 and 2006.

The reports don't prove that depression, anger, or hostility caused heart disease. But the findings held regardless of other heart disease risk factors, suggesting a stubborn link among those traits. "There is clearly a link between depression, anger, anxiety, stress, and outcomes in heart disease," says Philip Binkley, MD, FACC, professor of medicine at The Ohio State University.

Redford Williams, MD, director of the Behavioral Medicine Research Center at Duke University says that he "absolutely" considers chronic anger, hostility, or depression to be risk factors for heart disease, just like hypertension or high cholesterol. Cardiologist Pamela Douglas, MD, of Duke University, also sees a strong link between depression and heart disease but she says it's not clear which comes first, depression or heart disease. "It's sort of a chicken-or-the-egg issue," Douglas says.

All three experts agree that other heart disease risk factors often accompany depression -- and it never hurts to screen for heart hazards. And if you know your patient has heart disease, they should be screened for depression, according to guidelines set in September 2008 by the AHA.

As noted earlier, the new report on depression and heart disease showed a possible link between antidepressant use and the risk of sudden cardiac death. "The question is, is that just because the antidepressants were a sign of a more severe depression or was it a result of something about the antidepressants themselves?" Williams asks.

Williams notes that some tricyclic antidepressants are known to have effects on cardiac arrhythmias. But the new report doesn't show what kind of antidepressants the patients were taking or other details about their antidepressant use. Douglas agrees that the antidepressant findings aren't clear and says, "Don't take 'em if you don't need 'em." Douglas and Binkley say studies haven't proven that treating depression (or hostility and anger) eases heart disease.

It is worth remembering that EBT has been shown to have a negative predictive value approaching 100%. The test can be completed in minutes without drugs or preparation. It is one-third the cost of stress nuclear imaging and up to one-half the cost of stress echocardiography. Thus, peace of mind or a precise clinical plan for addressing problems can help reduce patient’s anxiety and help protect their good health.

J.A. Rumberger, M.D. FACC

Medical Director, PrevaHealth