Lack of Exercise Explains Depression-Heart Link

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The below may be of interest:

Lack of Exercise Explains Depression-Heart Link

http://well.blogs.nytimes.com/2008/11/26/lack-of-exercise-explains-

depression-heart-link/

For years cardiologists and mental health experts have known that

depression raises risk for heart attack by 50 percent or more.

But what hasn't been clear is why depressed people have more heart

problems. Does depression cause some biological change that increases

risk? Does the inflammatory process that leads to heart disease also

trigger depression?

The answer may be far simpler. A new study suggests that people who

are depressed are simply less likely to exercise, a finding that

explains their dramatically higher risk for heart problems.

Researchers, led by doctors from the Veterans Affairs Medical Center

in San Francisco, recruited 1,017 participants with heart disease to

track their health and lifestyle habits. As they expected, those

patients who had symptoms of depression fared worse. About 10 percent

of depressed heart patients had additional heart problems, during the

study, compared with 6.7 percent of the other patients. After

controlling for other illnesses and the severity of heart disease,

the finding translates to a 31 percent higher risk of heart problems

among the depressed people, according to the study published this

week in the Journal of the American Medical Association.

But once the researchers factored in the effect of exercise, the

difference in risk among depressed people disappeared. In the same

study, patients who didn't exercise, whether or not they were

depressed, had a 44 percent higher risk of heart problems, after

controlling for a variety of factors including medication adherence,

smoking and other illnesses.

The findings are important because some earlier studies have

suggested a link between antidepressant use and lower heart risk. The

explanation may be that patients who take antidepressants start to

feel better and take care of themselves, adopting healthy behaviors

including exercise. In a study of nearly 2,500 heart-attack patients,

published in the Journal of the American Medical Association in June

2003, behavioral therapy to treat depression didn't change survival

rates compared with patients who received regular care. But among

about 20 percent of patients in the study who ended up on

antidepressants, the risk of dying or suffering a second nonfatal

heart attack was 42 percent lower. Another study, called Sadheart

(which stands for Sertraline Antidepressant Heart Attack Randomized

Trial) showed the death rate from heart-related problems was 20

percent lower among patients taking the drug, although the data

weren't statistically significant.

The research suggests that doctors treating patients for depression

should also talk to them about their lifestyle habits, and encourage

them to exercise. The findings, say the researchers, suggest that the

heart problems associated with depression " could potentially be

preventable. "

The evidence that health behaviors fully explain the link between

depression and heart disease in this study is convincing, says Dr.

A. Whooley, professor of medicine, epidemiology and

biostatistics at the University of California, San Francisco.

However, she notes the study is limited to older men with stable

coronary disease, and as a result, more study is needed of women and

other patients with heart disease.

It remains an open question whether the study findings will change

the way doctors counsel their patients. " The clinical practice

question is a challenging one, " says Dr. Whooley. " It's easy for us

to tell patients to exercise, take their medicines, and refrain from

smoking, but actually changing health behaviors is very difficult. "

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Carruthers

Wakefield, UK