The association between depression and coronary heart disease incidence

The evidence from research studies linking depression to excess risk for co ronary heart disease (CHD) is strong and consistent. Depression is a risk f actor for new cardiovascular events in individuals initially free of CHD, a s well as for recurrent events and mortality among cardiac patients. The ri sk is not only limited to individuals who meet the criteria for a clinical diagnosis of major depression. Increasing levels of depressive symptoms, ev en in the absence of a major depressive episode, also carry higher CHD risk . What is less established, however, is the mechanism (or mechanisms) respo nsible for the effect of depression on CHD risk. Depression might increase CHD incidence by promoting or worsening coronary atherosclerosis (through e ffects on lipid profile, platelets and inflammatory factors), directly indu cing cardiac ischemia, increasing the risk for cardiac arrhythmias and sudd en death, and inducing unhealthy behaviors (cigarette smoking, decreased ad herence to medications and other lifestyle factors). Depression is common i n the U.S. and its prevalence is rising. It is important that individuals w ith depression are promptly identified and treated. This is likely to resul t in a reduction of CHD and related disability as well as health care costs among Americans. (C) 2000 Prous Science. All rights reserved.