Studies Link Depression, Heart Disease

A survey of medical studies shows a clear link between depression and cardiovascular disease. Dr. Sydney Spiesel, Yale Medical School professor and Slate medical columnist, talks with Madeleine Brand about how depression can contribute to heart trouble.

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MADELEINE BRAND, host:

From NPR News, this is DAY TO DAY. When you have heartache you may literally have heart ache. A recent study of thousands of women found a link between depression and heart disease. Dr. Sydney Spiesel contributes to the Medical Examiner column in the online magazine Slate. And he joins us now from his practice in Woodbridge, Connecticut. Welcome back to the program, Syd.

Dr. SYDNEY SPIESEL (Yale Medical School): Hi, Madeleine.

BRAND: Well, tell us about this new study on depression and heart patients.

Dr. SPIESEL: The study really is a summary of a - almost of a life's work by a woman named Mary Whooley of the San Francisco Department of Veteran Affairs Medical Center, where she put together many studies that she and other people had done. And she examined - initially examined about 7,500 elderly women and tracked them for seven years. And she administered sort of scales to determine how many different symptoms and signs of depression they had.

And what she found was that 7 percent of women with no signs of depression passed away during those seven years. In contrast, for women with three to five signs of depression, 17 percent of them died. In patients with six or more these signs of depression, 24 percent of them passed away.

BRAND: And they died from heart disease or from other factors?

Dr. SPIESEL: In her study, no. They died of a number of things.

BRAND: So how did she make the link between heart disease and depression?

Dr. SPIESEL: Well, she put together that with many, many other studies. There was a study of 700 men and women from Denmark who were followed for 27 years, which showed that they had a substantially greater risk of heart attack and death.

Another study of 8,000 men and women showed an increased risk of coronary heart disease in depressed patients.

BRAND: Now, the question that arises is what causes what? Does the depression cause the heart disease or does the heart disease cause the depression?

Dr. SPIESEL: There were also some studies which began with patients who were in good health and apparently free of cardiovascular disease. And even in these patients the risk of developing heart disease and of dying from it was increased by depression. So it looks as if at least some of the time the depression preceded the heart disease.

BRAND: You mention that depression precedes heart disease. How can it specifically cause heart disease? In other words, what are some of the factors?

Dr. SPIESEL: Among the sort of biological factors are that people who are depressed have a resting heart rate which is greater than people who are not depressed, and that may play a role. If you measure the hormones that control blood pressure and heart rate, those are higher in depressed patients than in nondepressed patients. Some of the blood factors like platelets are more activated - we don't know why - but they're more activated in depressed patients, which could lead to a higher risk of blood clots forming in the small arteries of the heart.

There are also behavioral issues that may play a role. If you're depressed, you're more likely to smoke. And there's a clear relationship between smoking and an increased risk of heart disease and of death due to heart disease. If you're depressed you probably eat badly and you probably pay little attention to the heart disease risks in your diet. You're less likely to engage in exercise, and we know that exercise helps prevent heart disease. And if you're really depressed there's a good chance that you're poorly compliant with taking the medications that might help reduce the risk of heart disease or its serious effects.

BRAND: That's opinion from Dr. Sydney Spiesel of the Yale Medical School and Slate.com. Syd is also a practicing pediatrician in Connecticut. Good to talk with you Syd, as always.

Dr. SPIESEL: And always my pleasure.

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