Treating depression before onset of cardiovascular disease can cut risk of heart attack, stroke

Research led by Jesse C. Stewart, Ph.D., of the School of Science at Indiana University-Purdue University Indianapolis, is the first to find that treatment of depression before any apparent signs of cardiovascular disease can decrease the risk of future heart attacks and strokes by almost half.

"Previous studies we and others have conducted indicate that depression is a risk factor for cardiovascular disease. But past depression treatment studies involving cardiac patients have not shown the anticipated cardiovascular benefits. So we asked ourselves, what if we treated depression before the onset of cardiovascular disease? Could that cut the risk of heart attack and stroke? Our results suggest that the answer is yes," said Dr. Stewart, associate professor of psychology in the School of Science at IUPUI and affiliated scientist of the Indiana University Center for Aging Research.

The researchers followed 235 older, clinically depressed patients who were randomly assigned to standard care or to a collaborative care program involving antidepressants and psychotherapy.

Among the 168 patients with no cardiovascular disease at the start of the study, those who received collaborative care to treat their depression had a 48 percent lower risk of heart attack or stroke over the next 8 years than did patients who received standard care for their depression.

In contrast, collaborative care was not associated with a lower risk of a heart attack or stroke among the 67 patients with preexisting cardiovascular disease.

These findings suggest that depression treatment may need to be initiated before the onset of cardiovascular disease if cardiovascular benefits are desired.

The study, "Effect of Collaborative Care for Depression on Risk of Cardiovascular Events: Data from the IMPACT Randomized Controlled Trial," appears in the January 2014 issue of Psychosomatic Medicine.

"Lifestyle changes -- such as stopping smoking -- and blood pressure and cholesterol medications are important approaches to decreasing risk of heart attacks and strokes. Our findings, if confirmed in a larger clinical trial, could provide an important new approach - depression treatment - to preventing cardiovascular events," said Dr. Stewart.

He and his collaborators are seeking funding to conduct a larger randomized controlled trial to verify that treating depression earlier in the natural history of cardiovascular disease reduces the risk of heart attacks and strokes.

Depression affects more than 6.5 million Americans age 65 years or older, according to the National Alliance on Mental Health.

"In the near future, depression treatment may play an important role in reducing disability and death due to cardiovascular disease," said Dr. Stewart.