[ProCOR] Women's Heart Health: Women with recurrent depression more likely to develop arterial calcifications

["Barbara Roberts" <bhroberts@lifespan.ORG>]

"Coronary and Aortic Calcification in Women with a History of Major
Depression," an article published in the June 13, 2005 volume of the
Archives of Internal Medicine, found that women with recurrent depression
were more likely to develop arterial calcifications than women with no
history of depression.(1)  The article notes that several new studies report
an association between depressive symptoms and coronary heart disease (CHD).
The authors were interested in pinpointing the temporal relationship between
these two illnesses.  Because coronary and aortic calcifications are
precursors of CHD, authors hoped to identify risks factors for CHD before
the disease is clinically diagnosed.

Fifty-eight African American women and 152 white women were chosen as
participants in this study.  All women were aged 42-52, had menstruated at
least once in the past 3 months, and had no prior history of diagnosed heart
disease.  For 3 years, each participant reported for an annual visit and was
administered the Structured Clinical Interview for the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (SCID-IV).  Based on
the data after the 3 years of interviews, subjects were classified to have
either "no or single episode of depression," or "recurrent episodes of
depression."  At the third annual visit, electron beam tomography was used
to measure the extent of calcification in the coronary arteries and aorta in
each participant. Both coronary arteries and the aorta were given an
independent "calcium score" based on the amount of calcifications detected
in each arterial region.

53 of the 210 participants (25%) met the criteria of having a history of
recurrent major depression.  Women fitting into this category also had a
higher waist-hip ratio, suggesting a link between excessive weight gain and
chronic depression.  The study reports, "Women with recurrent depression had
more than double the odds of having any coronary calcification or being in
the high coronary calcification group compared with the remaining women."
Additionally, women with recurrent depression were 3 times as likely to be
in the high calcification group for the aorta.  Other cardiovascular risk
factors like BMI, triglyceride level, smoking, and education were all
controlled for in the statistical analysis.

To conclude, middle-aged women with a history of recurrent major depression
have an increased risk of developing both coronary and aortic
calcifications.  This study indicates that long-term exposure to depressive
symptoms possibly increases the development of calcifications, while a
single depressive episode has less cardiovascular effect.  The authors
hypothesize that depression may cause women to adopt poorer eating habits
and a sedentary lifestyle, two factors that can cause wait gain and the
development of the metabolic syndrome.  Keeping in mind this study's
results, identifying and intervening on female patients with recurrent
depression might lead to both improved mental and cardiovascular well-being.


As always, we welcome comments. 
 
1.  Agatisa, Patricia et al. Coronary and Aortic Calcification in Women with
a History of Major Depression. Arch Intern Med.  2005; 165:  1229-1236. 

Emily Clarke-Pearson
Brown Medical School, '07

Barbara H. Roberts, MD, FACC
ProCOR Contributing Editor, Women's Heart Health