The symposium on coronary heart disease (CHD) and depression highlighted some important as-pects of this relationship: epidemiology, pathophysiology, treatment and the role of social support.
Dr J. Jordan (Frankfurt, Germany) presented the epidemiological relationship between depression and CHD: people with depression have a RR from 1.5 to 4.4 to have CHD, in comparison with healthy people without depression, while people with CHD have a RR from 1.76 to 2.38 to get depression. There are anyway problems with the diagnosis of depression, as 19 different methods have been described in three metanalysis and there are disorders similar to depression that have to be differentiated (as adjustment disorders, post-traumatic stress, vital exhaustion and distressed personality).
Dr J.T. Parissis (Athens, Greece) detailed the pathophysiological mechanisms that link depres-sion with CHD: altered platelet function, increased immune reaction (with increase in adhesion molecules and TNFa and decrease in IL-10), endothelial dysfunction (reduced flow-mediated vasodilation), altered autonomic control (reduced heart rate variability, increased QT dispersion), predisposition to arrhythmias (increased ICDs’ shocks), reduced compliance and unhealthy life-style of patients, concomitant presence of other risk factors (high triglycerides, low HDL), side effects of antidepressant treatments (tricyclic antidepressants).
Dr. Van Melle (Groningen, The Netherlands) presented the data of metanalysis, with a RR = 2.6 of cardiovascular mortality in depressed patients. Treatment with selective serotonin reuptake inhibi-tors (SSRI) is not effective in depressed patients as a whole group, but is effective in high risk subsets: severe depression, recurrent depression, depression already present before CHD. Re-cent studies (ENRICHD, MIND-IT) show no advantage in mortality treating post-MI depression. He concluded that depression is a frequent co-morbid condition and its causality for CV prognosis is not yet proven.
Dr B Mautner (Buenos Aires, Argentina) detailed the link among social support, depression and CHD: depression increases the risk of post-MI mortality, but not for people who perceive a high level of social support; on the contrary, a low level of social support (LLSS) is indeed linked to CHD events, even if it is not clear what type of social support is most associated with clinical out-comes.