Depression and Cardiovascular Disease Flashcards Preview

CVPR: CV Unit II > Depression and Cardiovascular Disease > Flashcards

Flashcards in Depression and Cardiovascular Disease Deck (11)
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1
Q

Associations between depression and averse outcomes in CVD

A
  • depression increases risk of CAD by 1.5-2x in otherwise healthy individuals
  • depression may account for 3% of DALYs due to ischemic heart disease
  • 3% of general population is depressed vs. 20-30% of cardiac pts are depressed
  • predicts mortality after acute coronary syndrome
  • dose-response relationship: prognosis related to severity of depression
  • predicts adverse outcomes among heart failure patients (mortality and rehospitalization)
  • strongly associated w/poorer patient health status (e.g. symptoms burden, physical limitation,
2
Q

Major types of mechanisms for association of depression and CAD

A
  • physiologic mechanisms

- behavioral barriers to optimal CV care

3
Q

Tx for depresson that improve outcomes for CV pts

A
  • sertraline=SSRI –> used in pts w/ACS –> safe and improved depressive sx and quality of life
  • telephone-delivered depression care
  • collabortive care program = antidepressants + psychotherapy (IMPACT study)
4
Q

merits of depression screening in CV pts

A
  • 75% of depressed ACS pts go unrecognized

- can screen with 2 simple questions, and further w/PHQ-9 (patient health questionnaire)

5
Q

Physiologic derangements in depression

A
  • depressive symptoms –> high adrenergic state:
  • autonomic dysfunction
  • elevated cortisol
  • platelet activation
  • endothelial dysfunction
  • inflammation
6
Q

Amygdala role in physiological regulation & depression

A
  • perceives stress/fear –> mounts flight or fight response
  • fxnl MRI shows hyperreactive amygdala in depressive patients
  • constant fear –> high stress response
  • hypothesis: defective serotonin signaling –> amygdala dysfxn –> autonomic dysfxn and hypercortisolemia
7
Q

Behavioral mechanisms linking depression and CVD

A
  • depressed patients –> much less adherence to meds
  • more likely to smoke
  • much less physically active
  • less likely to engage in health care system and follow-up
8
Q

Depression treatment impact on outcomes

A
  • definitely improves: depression, quality of life, physiology
  • not definitively known to improve: adherence, costs of care, CV events
9
Q

First line tx of depression in cardiac pts

A
  • SSRIs = effective, safe, cost-effective
  • buproprion (Wellbutrin) = anti-depressant + smoking cessation aid
  • cognitive behavior therapy/problem solving therapy
  • exercise training/cardiac rehabilitation
10
Q

Cardiac tx for depression considerations

A
  • patient education about tx expectations
  • structured follow-up
  • dose/med adjustment
  • mental health for complicated/refractory cases
11
Q

Summary of Depression in CVD

A
  • depression is predictive of developing CVD
  • depression is prevalent among and associated w/adverse outsomes in CV pts
  • several mechanisms may explain these associations (biologic and behavioral)
  • there are safe and effective screening and tx strategies