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 “We found that the combination of high stress and high depression
symptoms was particularly harmful for adults with heart disease
during an early vulnerability period,” said lead author Carmela
Alcantara of Columbia University Medical Center in New York City.
Alcantara and colleagues followed more than 4,400 people age 45 and
older with coronary heart disease, a buildup of plaque in the
arteries which is the most common form of heart disease.
Between 2003 and 2007, participants had in-home examinations and
completed stress and depression questionnaires. For example, they
reported how often during the previous week they felt depressed,
lonely or cried, and how often during the past months they felt
overwhelmed or like life was out of their control.
Almost 12 percent of the participants had high stress, almost 14
percent had high levels of depression and 6 percent reported having
both.
After roughly six years of follow-up, 1,337 participants had a heart
attack or died.
The 6 percent of people with both high stress and depression were 48
percent more likely to die or have a heart attack within two and a
half years of the home visit than people without both of these risk
factors.
There was no increased risk over longer periods or for people with
either depression or stress, but not both, according to results in
the journal Circulation: Cardiovascular Quality and Outcomes.
“We were surprised that high stress, and high depression, alone did
not increase the risk of another heart attack or death, in analyses
that accounted for important medical, behavioral, and demographic
factors,” Alcantara told Reuters Health by email.
Coronary heart disease is the leading cause of death for men and
women in the U.S., according to the National Institutes of Health,
but it can be managed with medications and lifestyle changes.
Previous studies tied stress and depression to the development of
heart disease as well, though this study was limited to people who
already had the condition, Alcantara said.
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“More research is needed to understand why psychosocial factors like
these are so often tied to heart health in particular,” she said.
During periods of stress, the part of the nervous system that
regulate the heart and other organs “makes the heart beat harder and
faster causing blood pressure to increase, a potential cause of
heart attacks and strokes,” Dr. Phil Chowienczyk, who was not part
of the Circulation study, wrote in an email to Reuters Health.
In a recent paper in the journal Hypertension, Chowienczyk and
colleagues from the King's College London report that normally, the
body regulates blood flow by releasing a molecule that lets blood
vessels open wider to prevent blood pressure from rising too much.
People with high blood pressure seem to release less of that
molecule, particularly during stress, according to their findings -
and this may contribute to stress-induced cardiovascular crises.
Behavioral stress and depression management therapies may help
improve medical outcomes for people with heart disease, Alcantara
said, but more research is needed in that area.
SOURCES: http://bit.ly/1B1S14d
Circulation: Cardiovascular Quality and Outcomes, online March 10,
2015 and http://bit.ly/1KT5qXy
Hypertension, online March 2, 2015.
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