Coronary Artery Disease | Hypertension | Clinical Implications
The effects of psychological, social, and behavioral factors on
cardiovascular disease have garnered considerable clinical attention
and have been a primary focus of epidemiological and psychosomatic
medicine research for the past 30 years. Patients with severe mental
disorders have about twice the prevalence of the classic risk factors
for coronary artery disease (CAD) (Birkenaes et al. 2006).
Evidence from methodologically rigorous studies of a strong association between
CAD and depressive disorders is especially compelling (Shapiro 2005). The prevalence of major depression in patients with
CAD is much higher, especially after myocardial infarction, than
in the general population. Depression not only commonly occurs alongside
CAD but also negatively affects outcome in CAD. The magnitude of
the effects of depression on morbidity and mortality in CAD is on
a par with the effects of the recognized medical risk factors. Major
depression is a significant predictor of mortality after an acute
myocardial infarction, equal to the effect of predictors such as
history of myocardial infarction or indexes of cardiac function
(Carney et al. 2003; Frasure-Smith et al. 1993, 1995a).
In an epidemiological study that followed a cohort of 3,000 individuals
ages 55–85 for 4 years, major depression tripled the relative
risk of cardiac mortality in those without heart disease and quadrupled
it in those who did have cardiac disease (Penninx et al. 2001).
Patients hospitalized for unstable angina who also had depressive symptoms
were four times more likely to have myocardial infarction or die
the following year than were those without depression (after adjusting
for other factors) (Lesperance et al. 2000).