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Heart disease patients' death rate doubles if ...

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Published: 06:44, 29 July 2017   Update: 15:18, 26 July 2020
Heart disease patients' death rate doubles if ...

Risingbd Desk: Heart disease patients are twice as likely to suffer an early death if they suffer depression, new figures reveal.

Researchers tracked more than 24,000 patients for 10 years, and found that post-coronary artery disease depression was the single biggest predictor of death.

That remained the case even after they adjusted for factors such as age, race, diabetes, or high blood pressure.

A leading psychologist with the American Heart Association told Daily Mail Online the findings highlight the crippling impact depression has on one's physical health, and support the idea that the mental illness has a biological impact on our organs.

The research, by epidemiologists at Intermountain Medical Center Heart Institute in Utah, was released in the European Heart Journal, one of Europe's most prestigious peer-reviewed publications.

Dr May and the Intermountain Medical Center Heart Institute research team studied 24,138 patients who underwent angiographies, which determined they had coronary artery disease.

To detect subsequent depression, the researchers used standardized diagnostic coding system.

The patients with depression were placed into subcategories based on how long after their heart disease diagnosis the depression was identified.

Until now, most studies have looked at depression at a single point in time, such as within 30 days of a heart event or at the time of heart disease diagnosis.

Just a handful of studies have looked over the course of a year.

This study, however, has the unique distinction of tracking patients for an average of 10 years after their coronary artery disease diagnosis to see if they were ever diagnosed with depression.

In all, 15 percent, or 2,646 patients, were diagnosed with depression at some point during follow-up.

Of those, most of them (37 percent) were diagnosed more than five years after their first heart event, but the two diagnosis were linked.

The second most likely scenario was being diagnosed within a year of the first heart event, which was the case for 27 percent of patients with depression.

The rest were diagnosed between one and five years after their first event. 

This study reinforces previous research investigating the link between depression, heart disease, and increased risks of death.

It's already been shown that people with coronary artery disease don't live as long as their peers who don't have heart disease.

And while life expectancy has increased with better therapies, surgeries, and more aggressive treatment of identified risk factors, depression has come under increasing scrutiny as a risk factor that could make a difference, if properly treated.

'No matter how long or how short it was, patients were found to have twice the risk of dying compared to those who didn't have a follow-up diagnosis of depression,' said lead author Dr Heidi May.

'Depression was the strongest risk factor for dying, compared to any other risk factors we evaluated. That included age, heart failure, diabetes, high blood pressure, kidney failure, or having a heart attack or stroke.'

Dr Barry Jacobs, an AHA-affiliated psychologist in suburban Philadelphia, said the study adds to a growing swell of research that shows depression may have a much more aggressive physical impact on our bodies than previously thought. 

'It begs the question: is there something biological about depression? There is increasing evidence that there are hormonal changes and electrofunctioning changes which affect the heart's functioning,' Dr Jacobs, of Crozer-Keystone Health System, explains.

'For years, we have assumed that depression rates affect health because it makes people less likely to follow routines they need to stay healthy. Sometimes when people are depressed they engage in behaviors to make them feel better emotionally - eating a lot, smoking, drinking. But it can make them more prone to cardiac symptoms as well as death.

'But increasingly, research suggests the reason for the increased death rate is not strictly behavioral - there's a biological reason for it too.'

It is widely believed that people who suffer from depression also have reduced levels of serotonin released in their brain.

Dr Jacobs explains that, since the heart has serotonin receptors, it may be that decreased levels of serotonin affect the heart.

'This is not well-understood but, increasingly, research is showing it could be the case, and this study adds to that.'

As this field of research builds, cardiologists and psychologists are racing to catch up.
Dr May said the findings emphasize the importance of continual screening of depression for all heart disease patients. 'Patients who have depression need to be treated for it to improve not only their long-term risks but their quality of life,' she said.

'I hope the takeaway is this: it doesn't matter how long it's been since the patient was diagnosed with coronary artery disease. Continued screening for depression needs to occur.

'After one year, it doesn't mean they're out of the woods. It should be ongoing, just like we keep measuring things like LDL cholesterol.'

However, Dr Jacobs warns that the medical community is still playing catch-up, and for now patients should be proactive about checking that their doctors have screened them for everything. 

'Doctors do not always do it,' Dr Jacobs warned.

'Primary care doctors in this day in age routinely do so - we carry out a PHQ (patient health questionnaire) for every adult patient that walks through the door. But most cardiologists don't.

'It will be important for patients not to assume that they will get tested, but to ask their doctor directly. With this new research we have new impetus for every heart disease patient to ask their doctors to screen them for depression.'
In the meantime, he said, anyone who has suffered a cardiac arrest or received a heart disease diagnosis should go easy on themselves and be wary of the emotional toll it will take on them.
'All patients should keep in mind that there are normal emotional reactions to having a heart attack or a diagnosis,' he said.

'This could include anxiety, sadness, sometimes anger. Those are all normal. For most people, they are facing their mortality for the first time.

'However, depression could deter people from following their doctor's advice, so people have to make a re-doubled effort.

Source: The Mail


risingbd/July 29, 2017/Mukul

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