Depression and cardiovascular disease in women
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Corresponding author Teresa Caulin-Glaser, MD Ohio State University, McConnell Heart Health Center, 3773 Olentangy River Road, Columbus, OH 43214, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2008, 2:233 –238 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2008 by Current Medicine Group LLC
Cardiovascular disease is the leading cause of death in men and women in the United States. Despite this statistic, many women believe they are more likely to die of breast cancer than heart disease. Moreover, epidemiologic studies have identified sex-based differences in the risk factors, evaluation, diagnosis, and treatment of patients with cardiovascular disease. Depression and symptoms of depression are common in patients with coronary heart disease. The association between depression and cardiovascular disease in women has been the focus of research in recent years. This article addresses sex differences in cardiovascular disease and the impact of depression.
Introduction Cardiovascular disease (CVD) is the leading cause of death in the United States and most developed countries, accounting for more than 900,000 deaths annually in the United States alone [1]. Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, dietary habits, alcohol intake, and physical inactivity account for most of the risk of myocardial infarction (MI) worldwide in both sexes and at all ages [2]. Emotional factors such as depression have been associated with the development of atherosclerosis. The lifetime risk of major depression is 7% to 12% for men and significantly higher in women, with risks as great as 20% to 25% [3]. The risk appears to be independent of age, tobacco use, cholesterol, diabetes mellitus, obesity, and exercise. The INTERHEART study identified modifiable risk factors for MI in more than 25,000 patients in 52 countries [4]. The investigators demonstrated in a multivariate model that psychosocial factors including depression were significant risk factors for MI. These
fi ndings were consistent across countries, in different ethnic groups, and in men and women. Because the prevalence of depression in women is high and depression is a predictor of coronary heart disease incidence, progression, and mortality, it is important to assess the impact of psychosocial variables and targeted interventions on cardiovascular outcomes in women.
Sex Differences in Morbidity, Mortality, and Treatment of Coronary Heart Disease More than 500,000 women in the United States die from CVD every year [5]. Death from CVD in women is nearly twice as common as deaths due to all forms of cancer combined. An estimated one of every three women will die from MI, stroke, or hypertensive disease. According to the American Heart Association’s statistics for 2003, the annual direct and indirect health cost for CVD is about $274 billion. Most women are approximately 10 years older than men at the time of presentation with CVD [6]. Women also are more likely to initially present with angina as o
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