Cheer up! It may be the only thing that saves you. New evidence shows that depression is a major risk factor for heart disease.
Some of the latest studies indicate that being depressed can be even worse for your heart than having high cholesterol or smoking. About 10 years ago there was a marked shift in research into heart disease. Instead of focusing on all the usual tangibles, like exercise and diet, researchers turned again to look at behavioural and psychological factors.
They came up with the notion of a Type D personality. The D stands for distressed, and this personality type is usually identified by two components: the continual experience of negative emotions and the inhibition of social expression of these emotions.
Studies show that among in-patients undergoing cardiac rehabilitation, deaths from cardiac causes are increased fourfold in those with a Type 1) personality, even after controlling for conventional risk factors. This suggests that the Type I) personality is a risk factor at least equivalent in importance to the other ‘conventional’ coronary-disease prognostic factors.
About 40 per cent of people who have had a heart attack become depressed afterwards (see the following section). Often their depression goes unrecognised and, therefore, untreated, yet these people’s risk of another heart attack in the next 12 months is two to five times higher than the risk for those without depression.
So, how do you know if you’re just a bit sad and stressed or if you are actually depressed?
If you are depressed, feelings of sadness are usually accompanied by a set of physical symptoms such as sleep disturbance, fatigue, loss of motivation, pleasure or self-confidence, and some impairment of cognitive functions such as memory, concentration or attention.
While women tend to express their depression through tearfulness and despondency, men usually express little emotion. Consequently their depression is less easily recognised and their risk of heart disease through silent depression is higher. This is enough to generate anxiety, which, of course, is a risk factor in itself.
Studies of people with pre-existing heart disease show that anxiety can he predictive of recurrent heart-disease events. In one study a group of normal male students was assessed for anxiety. The group was then followed for 30 years. During that time, those who had been anxious at enlistment had a risk of sudden death five to six times greater than that of the other students. The anxious students’ risk of a fatal heart attack was two to three times greater.
The good news is that intervention can help. By identifying and treating depression, doctors can control this risk factor for heart disease.
Some 30 years ago, it was commonly believed that Type A personalities were most susceptible to premature heart disease and heart attacks. Type A people are aggressively trying to achieve more and more in less and less time. As part of this struggle they are repeatedly facing opposition from other people and having to deal with difficult situations. The anger and irritability rather than their drive and ambition are probably the factors that raise their risk of heart disease. Like other heightened emotional states, anger can affect blood pressure and heart rate, and can actually cause spasm in the coronary arteries.
Another interpretation is that, despite their external success, Type A people are emotionally isolated. They are engaged in a lifestyle that guarantees a high level of social isolation, not only from acquaintances but also from their immediate family.
It is recognised that poor social support, which includes loneliness and isolation, is predictive of coronary heart disease.
The researchers responsible for constructing the Type A category implied that the rise in human loneliness might have been one of the most serious sources of cardiovascular disease in the 20th century.
The idea was not new. The lethal power of loneliness and grief has been recognised for centuries. Two hundred years ago grief was openly stated as a cause of death. In today’s medicalised world, however, a ‘broken heart’ would never be explanation enough. Modern death certificates need scientific terms such as atherosclerosis and ventricular fibrillation.
But intuitively, physicians know about the potency of anguish and how it manifests in the extraordinary phenomenon of coincidental death, when two people who are emotionally close die within a short period of each other.
Research into the effects of mood disorders on heart disease over the past 10 years has attempted to show, on the most basic chemical level, the interplay between psychology and physiology in the heart. It shows, for example, how depression can make the platelets in the blood more sticky, which makes their host ultimately more susceptible to a heart attack. The National Heart Foundation has no official position on the role of depression and anxiety as risk factors but is currently reviewing the issue.
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