Cardiac Patients Should Beware of ‘Psychosocial Perfect Storm’

A new study should be a warning message to cardiac patients experiencing mental health issues.

Investigators discovered that for people with a cardiac diagnosis, a combination of stress and depression can significantly increase the risk of a heart attack and death.

Researchers followed nearly 5,000 people for an average of six years examining the effect of high stress levels and significant depressive symptoms.

They discovered that risk is amplified when both conditions are present, thus validating the concept of a “psychosocial perfect storm.”

The new research has been published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

“The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use, and health risk behaviors,” said Carmela Alcántara, Ph.D., lead author of the study and associate research scientist at Columbia University Medical Center in New York.

Study participants included 4,487 coronary heart disease patients, 45 years and older, enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

During in-home examinations and self-administered questionnaires from 2003-07, participants were asked how often during the past week they felt depressed, lonely or sad, or had crying spells.

To determine stress levels, participants were asked how often during the past month they felt they were unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems, and felt things were going their way.

About six percent reported both high stress and high depression. Then, during an average six-year follow-up, 1,337 deaths or heart attacks occurred.

Researchers found that the short-term risk of death or heart attack increased 48 percent for those in the high stress-high depressive symptoms group, compared with those in the low stress-low depressive symptoms group.

The elevated risk was most strongly associated with death rather than heart attack. Investigators say that although the deaths may have been related to a cardiovascular event, additional research is necessary.

The risk was significant only during the first two-and-half years from the initial home visit, and wasn’t significant for those experiencing either high stress or high depressive symptoms alone, but not both at the same time.

Researchers believe the findings may challenge traditional research models that only focus on depression and its impact on patients with heart disease.

Behavioral interventions that could help heart disease patients manage both stress and depression better, may be beneficial, suggest the authors.

Source: American Heart Association