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Depression and cardiovascular disease: have a happy day—just smile!

Bertram Pitt, Patricia J. Deldin
DOI: http://dx.doi.org/10.1093/eurheartj/ehq031 1036-1037 First published online: 18 February 2010

This editorial refers to ‘Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey’, by K.W. Davidson et al. on page 1065

The relationship between cardiovascular disease and depression poses intriguing research questions, particularly for co-morbid treatment. Preliminary studies have indicated that patients with early-onset depression are at a significantly increased risk for developing cardiovascular disease (CVD) after correcting for cardiovascular risk factors, and this effect occurs even in the absence of a diagnosis of major depression.1 Depression increases the risk of coronary artery disease by 1.5–2 times in otherwise physically healthy individuals.2 In addition, patients with CVD such as myocardial infarction, stroke, heart failure, and atrial fibrillation are at increased risk of developing depression and, when depression develops, cardiovascular risk is exacerbated further.2,3 Patients with treatment-resistant depression (failure to respond to a single trial of antidepressant) after an acute coronary syndrome are at even greater cardiovascular risk.4

The use of antidepressants, such as selective serotonin uptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), does not appear to mitigate cardiovascular risk associated with depression, despite altering one or more of the physiological abnormalities linking CVD to depression such as increased inflammatory cytokines, a decreased circulation of endothelial progenitor cells, and a deficiency in nitric oxide availability.57 Nor …

*Corresponding author. Tel: +1734 936-5260, Fax: +1 734 9365256, Email: bpitt{at}umich.edu