Epidemiology and Management of Depression Following Coronary Heart Disease Diagnosis in Women
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WOMEN AND CARDIOVASCULAR DISEASE (J ROBINSON, SECTION EDITOR)
Epidemiology and Management of Depression Following Coronary Heart Disease Diagnosis in Women Siqin Ye & Ellen-ge Denton & Lauren T Wasson & Karina W Davidson
Published online: 23 February 2012 # Springer Science+Business Media, LLC 2012
Abstract Coronary heart disease (CHD) and depression are both highly prevalent in women. Importantly, depression is associated with significantly elevated morbidity and mortality in women with CHD. There are intriguing speculations about biological mechanisms underlying this association, such as endothelial dysfunction, subclinical atherosclerosis, inflammation, and autonomic dysregulation. Social and behavioral mechanisms, such as lack of social support and physical inactivity, have also been shown to play important roles. Unfortunately, many randomized clinical trials of counseling and pharmacologic interventions for depression in patients with CHD have failed to improve cardiovascular outcomes, and in fact have raised the possibility that interventions might be harmful in women. Several recent trials of new treatment strategies, however, have been more effective S. Ye Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 9-309, New York, NY 10032, USA e-mail: [email protected] E.-g. Denton Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH 9-309, New York, NY 10032, USA e-mail: [email protected] L. T. Wasson Department of Medicine, Columbia University Medical Center, 177 Ft. Washington Avenue, 6-Center, New York, NY, USA e-mail: [email protected] K. W. Davidson (*) Department of Medicine, Columbia University Medical Center, 622 West 168th St, PH9 Room 9-314A, New York, NY 10032, USA e-mail: [email protected]
in improving depressive symptoms and quality of life and deserve further investigation. In this review, we summarize recent findings with regards to the epidemiology, etiology, diagnosis, and management of depression in women diagnosed with CHD. Keywords Depression . Women . Epidemiology . Management . Coronary heart disease
Introduction Despite advances in prevention and treatment, cardiovascular disease (CVD) remains the leading cause of death for women in the United States, accounting for>300,000 deaths per year [1]. Depression is common in patients with CHD: around 20% meet criteria for major depression, and up to 50% experience some depressive symptoms [2]. Furthermore, depression has been shown to be independently associated with significantly increased risk for recurrent cardiovascular events and mortality [2, 3]. Similar to the general population, women with CHD are much more likely to experience depression as compared to men, and it has been argued that this partly explains why women face increased risk of death after myocardial infarction (MI) [4]. Due to these considerations, depression screening and treatment for patients with CHD has been recommended by both the 2008 American Heart Association (AHA) Science Advisory on Depr
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