Koroner kalp hastalığı için bir risk etkeni olarak depresyon

Depresyon bir risk etkeni olarak uzun süredir kardiyovasküler hastalıklarla ilişkilendirilmektedir. Bu yazıda depresyonun koroner kalp hastalığı için bir risk etkeni olarak araştırıldığı çalışmalarda elde edilen veriler ve depresyonun koroner kalp hastalığını hangi mekanizmalar yoluyla etkileyebileceği konusundaki görüşler gözden geçirilmiştir. Majör depresyonun koroner arter hastalığı olan kişilerde sonraki kardiyak olaylar için kestirim gücü olduğu, koroner kalp hastalığı olan veya myokard infarktüsü geçiren hastalarda mortaliteyi artırdığı saptanmıştır. Epidemiyolojik veriler depresyonun koroner kalp hastalığı gelişiminde bağımsız bir risk etkeni olduğunu göstermektedir. Depresyon ile kardiyak hastalıklar arasındaki ilişkinin altında yattığı ileri sürülen bazı mekanizmalar şunlardır: Antidepresan kardiyotoksisitesi, ana kardiyak risk etkenlerinin artışı, koroner hastalık şiddeti ile ilişki, kardiyak önleme ve tedavi rejimlerine uyumsuzluk, kardiyak otonomik tonun değişmesi, pıhtılaşma mekanizmalarının etkilenmesi, enflamatuar süreçlerle ilgili değişiklikler. Depresyonun tedavi edilmesinin kardiyovasküler morbidite ve mortaliteyi azaltıp azaltmadığı ile ilgili kesin veriler yoktur. Ancak, depresyonun etkin tedavisi bu hastaların yaşam kalitesini artıracaktır. Kardiyovasküler hastalığı olan kişilerdeki depresyonda en uygun tedavi yönteminin belirlenmesi için çalışmalara gerek vardır.

Anahtar Kelimeler:

Risk faktörleri, Depresyon, Depresif bozukluk, majör, Kalp hastalıkları, Koroner hastalık

Depression as a risk factor for coronary heart disease

Depression has long been associated with cardiovascular disease as a risk factor. This article reviews the studies on depression as a risk factor for coronary heart disease and potential mechanisms through which depression may affect heart disease. It has been found that major depression predicts subsequent cardiac events in patients with coronary artery disease, and increases mortality in patients with coronary heart disease and in patients who survived myocardial infarction. Epidemiologic data suggest that depression is an independent risk factor in the development of coronary heart disease. Some potential mechanisms thought to underlie the association between depression and cardiac diseases are antidepressant toxicity, increase of major cardiac risk factors, association with coronary disease severity, noncompliance to cardiac prevention and treatment regimens, altered cardiac autonomic tone, changes in coagulation mechanisms and inflammatory processes. At present, it is not clear whether treating depression will reduce cardiac morbidity or mortality. However, effective treatment of depression will enhance quality of life in these patients. Further studies are needed to determine the most appropriate treatment of depression in cardiovascular disease.

Keywords:

Risk Factors, Depression, Depressive Disorder, Major, Heart Diseases, Coronary Disease,

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1. Gala C, Galetti F, Invernizzi G. Depression and cardiovascular disease. MM Robertson, CLE Kat ona (eds): Depression and Physical III ness'ta. Guilford, John Wiley & Sons, 1997, s.209-223.
2. Shapiro PA. Cardiovascular disorders. BJ Sadock, VA Sadock (eds): Comprehensive Textbook of Psychiatry'de. Yedinci baskı, Philadelphia, Lippincott Williams d Wilkins, 2000, s.1797-1803.
3. Carney RM, Freed/and KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity. A review of potential mechanisms. J Psychosom Res 2002; 53:897-902.
4. Halperin P. Heart disease. MG Wise, JR Rundell (eds): Textbook of Consultation-Liaison Psychiatry'de. İkinci baskı, Washington, American Psychiatric Publishing, 2002, s.536-545.
5. Black D W, War rack G, Winokur G. The Iowa recordlinkage study, 3: excess mortality among patients with "functional" disorders. Arch Gen Psychiatry 1985; 42:82-88.
6. Rabins PV, Harvis K, Koven S. High fatality rates of late-life depression associated with cardiovascular diseases. J Affect Disord'1985; 9:165-167.
7. Carney RM, Rich M W, Tevelde A, Sain i J, Clark K, Jaffe AS. Major depressive disorder in coronary artery disease. Am J Cardiol 1987; 60:1273-1275.
8. Frasure-Smith N, Lesperance F, Talajic M. Depresion following myocardial infarction: impact on 6-month survival. J Am Med Assoc 1993; 270:1819-1825.
9. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91:999-1005.
10. Lesperance F, Frasure-Smith N, Theroux P. Depression influences 1-year prognosis in unstable ngina (abstract). J Am Coil Cardiol 1998; 333:208A.
11. Connerney I, Shapiro PA, McLaughlin JS, Bagiella E, Sloan RP. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001; 358:1766-1771.
12. Zipfel 5, Schneider A, Wild B, Lowe B, Junger J, Haass M ve ark. Effect of depressive symptoms on survival after heart transplantation. Psychosom Med 2002; 64:740-747.
13. Roose SP, Glass man AH, Se idman SN. Relationship between depression and other medical illnesses. J Am Med Assoc 2001; 286:1687-1690.
14. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med 1998; 158:1422-1426.
15. Aromaa A, Raitasalo R, Reunanen A, Impivaara O, Heliovaara M, Knekt P ve ark. Depression and cardiovascular diseases. Acta Psychiatr Scand 1994; 377(suppl):77-82.
16. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996; 93:1976-1980.
17. Rugulies R. Depression as a predictor for coronary heart disease: a review and meta-analysis. Am J Prev Med 2002; 23:51-61.
18. Glassman AH, Roose SP, Bigger JT. The safety of tricy die antidepressants in cardiac patients. Risk-benefit considered. J Am Med Assoc 1993; 269:2673-2675.
19. Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association of use of tricy die agents. Am J Med 2000; 108:2-8.46.Carney RM,
20. Carney RM,Freedland KE, Rich M W, Jaffe AS. Depression as a risk factor for cardiac events in established coronary heart disease: a review of possible mechanisms. Ann Behav Med 1995; 17:142-149.
21. Wells KB, Rogers W, Burnam A, Greenfield S, Ware JE. How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study. Am J Psychiatry 1991; 148:1688-1696.
22. Pfohl B, Rederer M, Coryell W, Stangl D. Association between post-dexamethasone cortisol level and blood pressure in depressed inpatients. J Nerv Ment Dis 1991; 179-44-47.
23. Glassman AH, Helzer JE, Covey LS, Cottier LB, Stetner F, Tipp JE ve ark. Smoking, smoking cessation, and major depression. J Am Med Assoc 1990; 264:1546-1549.
24. Carney RM, Blumenthal JA, Stein PK, Watkins L, Catellier D, Berkman LF ve ark. Depression, heart rate variability, and acute myocardial infarction. Circulation 2001:104:2024-2028.
25. Penninx BWJH, Guralnik JM, Ferucci L, Simons ick EM, Deeg DJH, Wallace RB. Depressive symptoms and physical decline in community dwelling older persons. J Am Med Assoc 1998; 279:1722-1726.
26. Anda R, Williamson D, Jones D, Macera C, Eaker E, Glassman A ve ark. Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of US adults. Epidemiology 1993; 4:285-294.
27. Clouse RE, Freedland KE, Carney RM, Griffith P, Lustman PJ. Depression accelerates the presen tation of coronary heart disease in women with diabetes mellitus. Psychosom Med 2001; 63:103.
28. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Char/son M. Vascular depression hypothesis. Arch Gen Psychiatry 1997; 54:915-922.
29. Krishnan KR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry 1997; 154:497-501.
30. Greenwald BS, Kramer-Ginsberg E, Krishnan DRR, Ash tar i M, A upper I e PM, Pat e I M. MRI signal hyperintensities in geriatric depression. Am J Psychiatry 1996: 153:1212-1215.
31. Lesperance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996; 58:99-110.
32. Lyness JM, Caine ED. Vascular disease and depression. Models of interplay between psychopathology and medical comorbidity. GM Williamson, DR Shaffer, PA Parmelee (eds): Physical! Illness and Depression in Older Adults. A Handbook of Theory, Research, and Practice'ta. New York, Kluwer Academic/Plenum, 2000, s.31-49.
33. Lyness JM, Moynihan JA, Williford DJ, Cox C, Caine ED. Depression, medical illness, and inter/o'kin-1 beta in older cardiac patients. Int J Psychiatry Med 2001; 31:305-310.
34. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment. Arch Int Med 2000; 160:2101-2107.
35. Carney RM, Freedland KE, Eisen S, Rich M W, Jaffe AS. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psycho/1995; 14:88-90.
36. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry 1998; 155:4-11.
37. Guinjoan MS, Guevara MSL, Correa C, Schauffele SI, Nicola-Siri L, Fahrer RD ve ark. Cardiac para-sympathetic dysfunction related to depression in older adults with acute coronary syndromes. J Psychosom Res 2004; 56:83-88.
38. Watkins LL, Grossman P, Krishnan R, Blumenthal.JA. Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosom Med 1999; 61:334-340.
39. Sayar K, Güleç H, Gökçe M, Ak I. Heart rate variability in depressed patients. Klinik Psikofarmakoloji Bülteni 2002; 3:130-133.
40. Otte C, Marmar CR, Pipkin SS, Moos R, Browner WS, Whooley MA. Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: The Heart and Soul Study. Biol Psychiatry 2004; 56:241-247.
41. Fimognari FL, Piccirillo G, Lama J, Paganica P, Monte- leone G, Gianni W, ve ark. Associated daily biosynthesis of cortisol and thromboxane A2: A preliminary report. JLab Clin Med 1996; 128:115-121.
42. Chrapko WE, Jurasz P, Radomski M W, Lara N, Archer SL, Le Melledo JM. Decreased platelet nitric oxide synthase activity and plasma nitric oxide metabolites in major depressive disorder. Biol Psychiatry 2004; 56:129-134.
43. Rogers KM, Bonar CA, Estrella JL, Yang S. Inhibitory effect of glucocorticoid on coronary artery endothelial function. Am J Physio I Heart Circ Physio 12002; 283:H1922-H1928.
44. Wallerath T, Witte K, Schafer SC, Schwarz PM, Preiiwitz W, Wohlfart P ve ark. Down-regulation of the expression of endothelial NO synthase is likely to contribute to glucocorticoid-mediated hyper tension. Proc Natl Acad Sci USA 1999; 96:13357-13362.
45. Ghiadoni L, Donald AE, Cropley M, Mullen MJ, Oakley G, Taylor M ve ark. Mental stress induces transient 'endothelialdysfunction in humans. Circulation 2000; 102:2473-2478.
46. Markowitz JH, Matthews KA. Platelets and coronary heart disease: potential"psychophysiologic mechanisms. Psychosom Med 1991; 53:643-668.
47. Musselman DL, Tomer A, Manatunga AK, Knight BT, Porter MR, de Baets M ve ark. Exaggerated platelet reactivity in major depression. Am J Psychiatry 1996; 153:1212-1217.
48. Whyte EM, Pollock BG, Wagner WR, Mulsant BH, Ferrell RE, Mazumdar 5 ve ark. Influence of serotonin transporter-linked promoter region polymorphism on platelet activation in geriatric depression. Am J Psychiatry 2001; 158:2074-2076.
49. Laghrissi- Thode F, Wagner WR, Pollock BG, Johnson PC, Finkel MS. Elevated platelet Victor 4 and fi-thromboglobulin plasma levels in depressed patients with ischemic heart disease. Biol Psychiatry 1997; 42:290-295.
50. Kuijpers PMJC, Hamulyak K, Strik JJMH, Wellens HJJ, HonTg A. Beta-thromboglobulin and platelet factor 4 'levels in post-myocardial infarction patients with major depression. Psychiatr Res 2002; 109:207-210.
51. Greenberg BO, Tolliver TJ, Haung S, Li Q, Bengel D, Murphy DL. Genetic variation in the serotonin transporter promoter region affects serotonin uptake in human blood platelets. Am J Med Genet 1999; 88:83-87
52. Von Kanel R, Mills PJ, Fainman C, Dimsdale JE Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease? Psychosom Med 2001; 63:531-544.
53. Folsom AR, Qamhieh HT, Flack JM, Hilner JE, Liu K, Howard BV ve ark. Plasma fibrinogen: levels and correlates in young adults. The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol 1993; 138:1023-1036.
54. Dentino AN, Pieper CF, Rao MK, Currie MS, Harris T, Blazer DG ve ark. Association of interleukin-6 and other biologic variables with depression in older people living in the community. J Am Geriatr Soc 1999; 47:6-11.
55. von Kanel R, Dimsdale JE. Effects of sympathetic activation by adrenergic infusions on hemostasis in vivo. Eur J Haematol 2000; 65:357-69.
56. Letgahen S. Desmopressin-a haemostatic drug: state-of-the-art review. Eur J Anesthesiol1997; 14 (suppl):1-9
57. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999; 340:115-126.
58. Maes M, Bosmans E, De Jongh R, Kent's G, Vandoolaeghe E, Neels H. Increased serum IL-6 and IL-1 receptor antagonist concentrations in major depression and treatment resistant -depression. Cytokine 1997; 9:853-858.
59. Danesh J, Collins R, Appelby P, Peto R. Fibrinogen, C- reactive protein, albumin and white cell count: meta analyses of prospective studies of coronary heart disease. J Am Med Assoc 2000; 279:1477-1482.
60. Lesperance F, Frasure-Smith N, Theroux P, Irwin M. The association between major depression and levels of soluble intercellular adhesion molecule 1, interleukin-6, and C-reactive protein in patients with recent acute coronary syndromes. Am J Psychiatry 2004; 161:271-277.
61. Appels A, Bar FW, Bar J, Bruggeman C, de Baets M. Inflammation, depressive symptomatology, and coronary artery disease. Psychosom Med 2000; 62:601-605.