Original articlesSevere depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease
Introduction
There is considerable evidence that clinical depression is a risk factor for cardiac morbidity and mortality in patients with coronary heart disease; that is, heart disease resulting from coronary atherosclerosis 1, 2, 3, 4, 5, 6, 7, 8. Moreover, relatively severe forms of depression are associated with a greater risk for cardiac events; for example, myocardial infarction, need for balloon angioplasty, coronary artery bypass surgery, or other cardiac-related hospitalizations. Lésperance et al. [9], for instance, found that 40% of acute myocardial infarction patients with both a history of major depression and major depression at the time of their myocardial infarction (MI) died in the year following the myocardial infarction, compared with 10% of patients who were depressed for the first time with relatively mild depression. Similarly, Barefoot et al. [2] found that patients with documented coronary heart disease who had moderate to severe depression had an 84% greater risk for mortality, and those with mild depression had a 57% greater risk, than did nondepressed patients with coronary disease.
These adverse effects of depression in coronary heart disease patients are believed to be due, at least in part, to dysregulation of the autonomic nervous system. Autonomic dysregulation, that is, a predominance of adrenergic activation and/or lack of parasympathetic modulation, has been found in medically well patients with major depressive disorder, as evidenced by elevated plasma and urinary catecholamines and their metabolites 10, 11, 12, 13, 14, 15, altered cardiac autonomic balance as measured by elevated resting heart rate 4, 16, 17, and decreased heart rate variability 18, 19, 20, 21, 22.
Attenuated heart rate variability is a well-known independent risk factor for mortality after myocardial infarction 23, 24. Decreased heart rate variability has been shown to predict subsequent mortality even when it is measured in stable patients 1 year after myocardial infarction [25] and in unselected consecutive patients without any recent cardiac events involving cardiac catheterization [26]. We have previously shown that heart rate variability is significantly lower in depressed patients with newly diagnosed coronary disease than in otherwise comparable nondepressed patients [18]. Although there were no significant differences between the depressed and nondepressed groups with respect to prescribed medications, the fact that some patients were taking cardiac medications, such as β-blockers, may have affected the heart rate variability results in the sample as a whole. Furthermore, the sample was too small to determine whether heart rate variability was lower in more severely depressed patients than in mildly depressed ones. Thus, the purpose of the present study was to determine whether moderately-to-severely depressed, unmedicated patients with stable coronary heart disease have lower heart rate variability than comparable mildly depressed or nondepressed patients.
Section snippets
Subjects
Medically stable patients with angiographically documented coronary disease were eligible to participate if they were ⩽75 years old and had no history or current evidence of congestive heart failure (the inability of the heart to pump sufficient blood to meet the needs of the body), a recent (within 6 months) myocardial infarction (heart attack), severe systemic illness, a noncardiac medical illness that could influence autonomic function, recent coronary artery bypass surgery or angioplasty,
Results
Of the 54 depressed and 40 nondepressed patients recruited for the study, 40 depressed and 30 nondepressed patients had recordings that were adequate for 24-hour heart rate variability analysis. As can be seen in Table 1, the groups were similar with respect to demographic and medical characteristics, except for a significantly greater pack-year smoking history among the severely depressed. The mean Beck Depression Inventory score for the moderately-to-severely depressed subjects was 28.2 ±
Discussion
In a previous study, we found that heart rate variability was lower in depressed than in nondepressed patients with newly diagnosed coronary disease, some of whom were taking cardiac medications such as β-blockers 9, 18. The present study extends this finding by documenting reduced heart rate variability in clinically depressed patients with stable coronary heart disease who had temporarily discontinued all cardiac medications. Although it is possible that there was a rebound effect on heart
Acknowledgements
This study was supported in part by Grant No. 2 R01 HL42427-04 from the National Heart, Blood and Lung Institute, National Institutes of Health, Bethesda, Maryland (Robert M. Carney, PhD, Principal Investigator).
References (44)
- et al.
Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrythmia Pilot Study (CAPS)
Am J Cardiol
(1990) - et al.
Depression and long-term mortality risk I patients with coronary artery disease
Am J Cardiol
(1996) - et al.
Cardiac regulation and depression
Psychiatric Res
(1987) - et al.
Depression is associated with reduced heart rate variability in patients with coronary heart disease
Am J Cardiol
(1995) Are affective disorders associated with alterations of heart rate variability?
J Affect Dis
(1994)- et al.
Decreased heart rate variability and its association with increased mortality after acute myocardial infarction
Am J Cardiol
(1987) - et al.
Frequency domain measures of heart period variability to assess risk late after myocardial infarction
J Am Coll Cardiol
(1993) - et al.
Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography
Am J Cardiol
(1988) - et al.
Efficient estimation of the heart period power spectrum suitable for physiologic or pharmacologic studies
Am J Cardiol
(1990) - et al.
Time domain measurements of heart rate variability
Cardiol Clin
(1992)
Time course of recovery of heart period variability after myocardial infarction
J Am Coll Cardiol
Major depressive disorder in coronary artery disease
Am J Cardiol
Effect of 21 mg transdermal nicotine patches and smoking cessation on heart rate variability
Am J Cardiol
Severity of coronary atherosclerosis correlates with the respiratory components of heart rate variability
Am Heart J
Major depressive disorder predicts cardiac events in patients with coronary artery disease
Psychosom Med
Depression following myocardial infarctionimpact on 6-month survival
JAMA
Significance of depression and cognitive impairment in patients undergoing programmed stimulation of cardiac arrhythmias
Psychosom Med
Affective disorders and survival after acute myocardial infarctionresults from the Post-Infarction Late Potential Study
Eur Heart J
Depression and 18-month prognosis after myocardial infarction
Circulation
Depression, psychotropic medication, and risk of myocardial infarctionprospective data from the Baltimore ECA follow-up
Circulation
Major depression before and after myocardial infarctionits nature and consequences
Psychosom Med
The peripheral kinetics of norepinephrine in depressive illness
Arch Gen Psychiatry
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