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 “We expect that the statement itself will come as quite a surprise
to most,” said Dr. Benjamin I. Goldstein from Sunnybrook Health
Sciences Center in Toronto, who chaired the committee that issued
the report.
“This is precisely what makes the statement so important and
potentially impactful; it takes a largely unrecognized and
under-appreciated body of evidence, and positions it squarely on
center stage,” Goldstein told Reuters Health in an email.
Goldstein and his coauthors say major depression affects nearly 9
percent of U.S. adolescents. Bipolar disorder, the fourth most
disabling condition, affects about 2.6 percent of U.S. adolescents.
The National Institute of Mental Health explains on its web site
that people with major depression have persistent severe symptoms
that interfere with their ability to work, sleep, study, eat, and
enjoy life. In bipolar disorder, which is less common, people have
mood changes that go back and forth between extreme highs (e.g.,
mania) to extreme lows (e.g., depression).
In developing the new scientific statement, Goldstein and his
colleagues evaluated the existing data at the behest of the AHA’s
Council on Cardiovascular Disease in the Young.
Although research on the association between these mood disorders
and heart disease is limited, what is available shows a significant
increase in traditional heart disease risk factors in adolescents
with major depression or bipolar disorder, the team reported in the
journal Circulation.
These risk factors include obesity, high blood pressure, and
unhealthy cholesterol levels.
Childhood maltreatment, sleep disorders, physical inactivity, and
smoking – factors common in adolescents with depression and bipolar
disorder – can also contribute to an increased heart disease risk.
Even the treatments (antidepressants and mood-stabilizing
medications) can cause weight gain and other metabolic changes that
increase the risk of heart disease, the statement points out.
Based on the available data, the authors say, these adolescents
should be considered to be at moderate risk for early heart disease.
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Prevention efforts should focus on maintaining a healthy weight and
blood pressure, healthy levels of cholesterol, and blood sugar in
the normal range. The first step in achieving these targets is
intensive lifestyle management that emphasizes regular physical
activity, a healthy-heart diet, and, if necessary, weight loss.
“When considering cardiovascular risk among youth with mood
disorders, screen more and take action earlier and at lower
thresholds,” Goldstein advised.
Dr. Viola Vaccarino from Rollins School of Public Health at Emory
University in Atlanta, who wasn’t involved in developing the
statement, told Reuters Health, “It is time to end the traditional
separation between mental health and physical health. Stigma from
mental disorders remains widespread and results in low recognition
and management of psychiatric problems outside of mental health
clinics. But cardiovascular disease and depression are linked
conditions; they both rank highest as causes of disability in the
United States, and (are) also rapidly growing worldwide.”
“Cardiovascular disease is a chronic, progressive condition that
starts in youth, even if the disease becomes clinically manifest
later in life,” Vaccarino concluded. “This is why identification of
risk conditions such as depression early in life provides an
important opportunity for cardiovascular disease prevention.”
SOURCE: http://bit.ly/1q3uqj1 Circulation, online August 10, 2015.
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