Cardiovascular Disease and Depression Flashcards
Depression increases the risk of CAD by _____ in otherwise physically healthy individuals
1.5-2x
True or False: Depression predicts incident CVD.
True.
Patients experiencing depressing are 2.7 times more likely to die from ischemic heart disease
True or False: Depression is more common in populations of CAD than compared to general population or other medical patients
True
What’s the prevalence (% range) for depression in CAD, HF, PAD, post-CABG, post-ACS?
20-40%!
True or False: Depression predicts mortality after acute coronary syndrome
True
True or False: Depression predicts adverse outcome among heart failure patients
True
True or False: Depression is strongly associated with worse patient health status
True
True or False: Depression predicts declines in patient health status
True. It’s the strongest predictor for declines in health status.
True or False: Depression is associated with higher costs of care
True.
What are physiologic reasons associated with depression and CVD?
Autonomic dysfunction (increases symp, reduces parasymp) Elevated cortisol (elevated BP) Platelet activation (from serotonin. leading to clots) Endothelial dysfunction Inflammation (inflammation markers are present)
What is the unifying hypothesis for why depression is associated with CVD?
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.
What are some behavioral mechanisms associated to depressed patients? (5)
Poor adherence to medications Poor lifestyle Poor self-management Poor recommended testing Poor follow-up
Is depression a causal factor or a marker? (Risk factor or risk marker?)
Not sure. In the end, it doesn’t matter. They should be treated to be better as a whole.
What was the SADHEART study?
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.
What was the MIND-IT study?
331 patients. Also didn’t find benefit for CV by using mirtazipine (for depression)
What was the IMPACT study?
235 patients treated with antidepressants. 48% had lower risk of CVD event over 5 years.
What’s the problem with a lot of these studies looking at depression treatment and CVD?
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.
What are first line treatments for depression?
Serotonin selective reuptake inhibitors (SSRIs)
Sertraline Citalopram Escitalopram Paroxetine Fluoxetine
Name 5 SSRIs
Sertraline Citalopram Escitalopram Paroxetine Fluoxetine
What is a common side effect of SSRI?
sexual dysfunction
What is the preferred SSRI for first line therapy?
Sertraline
What are second line treatments for depression?
Buproprion.
When should you consider using Buproprion?
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.
What medication should you be careful in using to treat depression in CVD patients?
St. John’s Wort. These have many interactions with cardiac medications
Which depression medications are contraindicated in patients with CVD?
Tricyclic antidepressants (amitriptyline, clomipramine, doxepin, imipramine) and monoamine oxidase inhibitors (phenelzineu, isocarboxazid, tranylcypromine)
True or False: Beta Blockers can cause depression
FALSE
