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Depression increases the risk for coronary heart disease, but its association with acute coronary syndrome (ACS) events remains unclear. These British researchers assessed the potential temporal association between self-reported depressed mood and onset of an ACS event that led to hospitalization in 295 patients (mean age, 60).
ACS was verified by ECG and laboratory tests; interviews occurred at a mean of 2.5 days after hospitalization. Using a 5-point scale (from none to extreme depressed mood), patients rated their depressive symptoms during the 2 hours before the onset of ACS symptoms and during the same period on the day before the ACS event. Patients also estimated the amount of time that they had felt depressed during the previous 6 months.
During the 2 hours before ACS onset, patients were 2.5 times more likely to have experienced any acute time-limited depressive symptoms and 5 times more likely to have experienced moderate-to-severe ones than during the corresponding time on the previous day. These associations were not explained by depression during the previous 6 months, by anger, or by medical risk factors.
Steptoe A et al. Acute depressed mood as a trigger of acute coronary syndromes. Biol Psychiatry 2006 Oct 15; 60:837-42.
Comment
It is difficult to know whether a retrospective global rating of depressed mood is reliable and whether depression is a prodromal symptom of ACS. However, the results are consistent with previous findings that anger triggers ACS. Perhaps, depressed mood affects platelet and vascular function and inflammatory cytokine levels, thus contributing to acute disruption of previously stable plaques and resulting in potentially life-threatening coronary states. Researchers need to study the potential cardiac benefits of treating recurrent acute depressive mood and the relationship of intermittently depressed mood or depressive disorders to coronary heart disease.