Cardiovascular Disease and Depression

Question 1

By what amount does depression increase the risk of dying from ischemic heart disease in patients without cardiovascular disease (CVD)?

Answer 1

2.7x times more likely

Question 2

Roughly what percent of ischemic heart disease are attributed to depression?

Answer 2

• 3%
  
  • 3.5million years of life lost
  • 250,000 years of life lived with disability

Question 3

What is the prevalence of depression in cardiovascular patient populations?

Answer 3

• 20-30%

Question 4

T/F: People with severe depression are more at risk of dying from ischemic heart disease than people with moderate depression?

Answer 4

• True
  
  • There is a dose-response relationship from not depressed through severely depressed

Question 5

What 5 physiologic derrangements is depression associated with?

Answer 5

1. Autonomic dysfunction
2. Elevated cortisol
3. Platelet activation
4. Endothelial dysfunction
5. Inflammation

Question 6

What is the root cause of depression causing increased risk of CVD?

Answer 6

• Depressed patients have defective serotonin signaling
  
  • i.e. - increased brain serotonin turnover
  • Leads to dysfunction of the amygdala
    
    • Leads to autonomic dysfunction and hypercortisolemia
      
      • Elevated catecholamines
      • Increased inflammation
      • Endothelial dysfunction
      • Platelet activation

Question 7

T/F: Depressed patients are equally compliant with medications, lifestyle changes, follow up etc. as non-depressed patients?

Answer 7

• False
  
  • Depressed patients are 2-4x less likely

Question 8

T/F: Patients who undergo treatment for depression experience decreased lieklyhood for CVD?

**Don’t need to memorize why**

Answer 8

• True
  
  • Significant decrease in platelt activation markers
  • Improved heart rate variability
  • Reduced inflammatorry markers
  • Normalized brain serotonin turnover

Question 9

Of what is estimated to be the total population of CVD patients with depression, what percent are recognized?

Answer 9

• Only 25% of CV patients with depression are recognized
  
  • Depression is under-recognized and under-treated in CV patients

Question 10

T/F: A two question depressino screen can be effective in ruling out depression?

Answer 10

• True
  
  • You can effectively rule out depresion by using a 2 question screen about feeling down/hopeless and having little interest/pleasure in doing things.

Question 11

What class of depression treatments are considered to be first line anf having the greatest safety profile?

Answer 11

• SSRI’s (Selective Serotonin Reuptake Inhibitor)
  
  • Sertaline
  • Citalopram
  • Escitalopram

Question 12

What class of antidepressants would be considered possible second line treatment?

Answer 12

• SNRI’s

Question 13

What class of antidepresseants are contraindicated in CVD patients?

Answer 13

• Contraindicated in CV patients
  
  • Tri-cyclic antidepressants
  • MAOi

Question 14

T/F: Beta blockers cause depression?

Answer 14

• False