It is widely accepted that depression increases the risk of coronary heart disease(CHD) in healthy people while,inindividuals withanexisting heart disease,depression is apredictor ofrecurrentcardiaceventsanddeath.Itseemsthatnew-onsetdepressionafteranacutecoronarysyndrome(ACS)andnotrecurrentdepressionmayworsenthecardiovascularoutcome, andithas been suggested, although notconclusively proved, thatdepressive somatic symptoms,couldbemorecardiotoxicthandepressedcognitivesymptoms.Bothpsychosocial(low social support,less adherence to treatment recommendations, physical inactivity) andbiologicalmechanisms (autonomicnervoussystem dysregulation,platelet and endothelial dysfunctions, inflammation, andneuroendocrine abnormalities) havebeen hypothesized to explain the linkbetween depression andthe increased risk of CHDoradverse cardiovascular prognosis. Randomized controlledclinical trials seemtosuggest thatdepression in CHDpatients is poor responsive to bothpharmacologicaland psychotherapeutic treatments. Nevertheless,thesetrialsprovidealsoarobustevidencethatCHDdepressedpatientsnonresponder to antidepressant treatmentsare at greater risk of adverse cardiac event than patients with successfullytreateddepression.Therefore,itisadvisablethatpsychiatrists,cardiologistsand general practitionerscoordinatetheireffortsinmanaging depression in CHDpatients.
Depression and coronary heart disease. Clinical characteristics, pathogenetic links and treatment issues.
Steardo L;
2012-01-01
Abstract
It is widely accepted that depression increases the risk of coronary heart disease(CHD) in healthy people while,inindividuals withanexisting heart disease,depression is apredictor ofrecurrentcardiaceventsanddeath.Itseemsthatnew-onsetdepressionafteranacutecoronarysyndrome(ACS)andnotrecurrentdepressionmayworsenthecardiovascularoutcome, andithas been suggested, although notconclusively proved, thatdepressive somatic symptoms,couldbemorecardiotoxicthandepressedcognitivesymptoms.Bothpsychosocial(low social support,less adherence to treatment recommendations, physical inactivity) andbiologicalmechanisms (autonomicnervoussystem dysregulation,platelet and endothelial dysfunctions, inflammation, andneuroendocrine abnormalities) havebeen hypothesized to explain the linkbetween depression andthe increased risk of CHDoradverse cardiovascular prognosis. Randomized controlledclinical trials seemtosuggest thatdepression in CHDpatients is poor responsive to bothpharmacologicaland psychotherapeutic treatments. Nevertheless,thesetrialsprovidealsoarobustevidencethatCHDdepressedpatientsnonresponder to antidepressant treatmentsare at greater risk of adverse cardiac event than patients with successfullytreateddepression.Therefore,itisadvisablethatpsychiatrists,cardiologistsand general practitionerscoordinatetheireffortsinmanaging depression in CHDpatients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
