Cardiovascular Disease and Depression

Question 1

Depression increases the risk of CAD by _____ in otherwise physically healthy individuals

Answer 1

1.5-2x

Question 2

True or False: Depression predicts incident CVD.

Answer 2

True.

Patients experiencing depressing are 2.7 times more likely to die from ischemic heart disease

Question 3

True or False: Depression is more common in populations of CAD than compared to general population or other medical patients

Answer 3

True

Question 4

What’s the prevalence (% range) for depression in CAD, HF, PAD, post-CABG, post-ACS?

Answer 4

20-40%!

Question 5

True or False: Depression predicts mortality after acute coronary syndrome

Answer 5

True

Question 6

True or False: Depression predicts adverse outcome among heart failure patients

Answer 6

True

Question 7

True or False: Depression is strongly associated with worse patient health status

Answer 7

True

Question 8

True or False: Depression predicts declines in patient health status

Answer 8

True. It’s the strongest predictor for declines in health status.

Question 9

True or False: Depression is associated with higher costs of care

Answer 9

True.

Question 10

What are physiologic reasons associated with depression and CVD?

Answer 10

Autonomic dysfunction (increases symp, reduces parasymp)
Elevated cortisol (elevated BP)
Platelet activation (from serotonin. leading to clots)
Endothelial dysfunction
Inflammation (inflammation markers are present)

Question 11

What is the unifying hypothesis for why depression is associated with CVD?

Answer 11

There is defective serotonin signaling which causes platelet activation and dysfunction of the amygdala. The dysfunction of the amygdala causes autonomic dysfunction and hypercortisolemia which causes elevated catecholamines, elevated inflammation markers, and endothelial dysfunction.

Question 12

What are some behavioral mechanisms associated to depressed patients? (5)

Answer 12

Poor adherence to medications
Poor lifestyle
Poor self-management
Poor recommended testing
Poor follow-up

Question 13

Is depression a causal factor or a marker? (Risk factor or risk marker?)

Answer 13

Not sure. In the end, it doesn’t matter. They should be treated to be better as a whole.

Question 14

What was the SADHEART study?

Answer 14

369 patients with depression after ACS were treated by placebo and sertraline. Improved depressive symptoms and QOL. However, benefit for CV events was not significant.

Question 15

What was the MIND-IT study?

Answer 15

331 patients. Also didn’t find benefit for CV by using mirtazipine (for depression)

Question 16

What was the IMPACT study?

Answer 16

235 patients treated with antidepressants. 48% had lower risk of CVD event over 5 years.

Question 17

What’s the problem with a lot of these studies looking at depression treatment and CVD?

Answer 17

They aren’t measuring if they treat the patients to curative rate of their depression so of course they still have depression and still don’t do well cardiovascularly.

Question 18

What are first line treatments for depression?

Answer 18

Serotonin selective reuptake inhibitors (SSRIs)

Sertraline
Citalopram
Escitalopram
Paroxetine
Fluoxetine

Question 19

Name 5 SSRIs

Answer 19

Sertraline
Citalopram
Escitalopram
Paroxetine
Fluoxetine

Question 20

What is a common side effect of SSRI?

Answer 20

sexual dysfunction

Question 21

What is the preferred SSRI for first line therapy?

Answer 21

Sertraline

Question 22

What are second line treatments for depression?

Answer 22

Buproprion.

Question 23

When should you consider using Buproprion?

Answer 23

When sexual dysfunction of SSRI is not tolerated or if concurrent smoking cessation is being considered.

Side effect of Buproprion is increased BP and insomnia. Buproprion is used short-term.

Question 24

What medication should you be careful in using to treat depression in CVD patients?

Answer 24

St. John’s Wort. These have many interactions with cardiac medications

Question 25

Which depression medications are contraindicated in patients with CVD?

Answer 25

Tricyclic antidepressants (amitriptyline, clomipramine, doxepin, imipramine) and monoamine oxidase inhibitors (phenelzineu, isocarboxazid, tranylcypromine)

Question 26

True or False: Beta Blockers can cause depression

Answer 26

FALSE