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February 1, 2002


Emory Heart Researcher Concludes Depression In Older Women Ups Risk For Heart Failure

Depression is sometimes described as a feeling of "heart-breaking" sadness. According to a study published in the current issue of Psychosomatic Medicine, depression in elderly women may literally contribute to the breaking down of the heart's ability to pump normally – the condition known as heart failure.

An Emory and Yale research team followed 2,501 people, all 65 years of age or over, for 14 years to assess the impact of depression on heart failure. According to study author Viola Vaccarino, M.D., Ph.D., of Emory University School of Medicine's Division of Cardiology, the researchers found that depression was indeed associated with an increased risk of heart failure. "We were surprised, however, to find that the adverse effect of depression on heart failure was present exclusively in women: women who had symptoms of depression at the beginning of the study were nearly twice as likely to develop heart failure than women without depression," Dr. Vaccarino says. "Among men, depression was not associated with heart failure risk. "

The researchers used data from the Yale Health and Aging Project (YHAP), a study of non-institutionalized elderly people living in New Haven, Connecticut. YHAP includes people from a variety of cultural and economic backgrounds -- making it representative of the elderly population in many communities of the United States. Approximately five percent of the men and nine percent of the women were found to have symptoms of depression severe enough to approximate a clinical diagnosis of depression when the study began. After 14 years, nineteen percent of the depressed women had developed heart failure, compared with 10 percent of the non-depressed women. However, only 12 percent of the depressed men developed heart failure -- approximately the same number of non-depressed men who developed the disorder.

Heart failure results when the heart loses its ability to pump blood efficiently, leading to symptoms such as fatigue and shortness of breath. Heart failure is a common and serious condition among the elderly, affecting both quality of life and life expectancy. Depression is also known to be highly prevalent among heart failure patients. But why are older women with depression more likely to develop heart failure? "We have several possible explanations, but we don't know the answer yet," says Dr. Vaccarino.

For example, she points out that depressed people are known to have elevated activation of the sympathetic nervous system, resulting in heightened production of so-called "stress" hormones such as noradrenaline that have been shown to influence the progression of heart failure. Depressed people may also not adhere to healthy diets or take their needed medications. However, these factors do not explain why depressed elderly men would not experience the same increase in heart failure as depressed older women.

"A possible explanation is that women may have a stronger physiological response to depression than men, thereby significantly increasing their risk of heart failure," says Dr. Vaccarino.

Dr. Vaccarino hopes this research will alert doctors to screen elderly women for not only coronary heart disease – already linked to depression – but also for heart failure. "Early diagnosis and treatment of depression may reduce the burden of morbidity and mortality due to heart failure in the elder population as well as reduce the public health costs associated with treating heart failure," she emphasizes.

The study was supported by a grant from the National Institute of Mental Health.

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