When you think of heart attacks, you might assume the most common causes are smoking, high cholesterol, or obesity. Mental health issues probably don't spring to mind. But a new study suggests that depression poses just as great a risk to your heart health as those more familiar heart disease contributors.
In a new analysis, German researchers looked at health information from 3,428 European men, ages 45 to 74, who were followed for 10 years. And it turned out, dying from cardiovascular disease during the study period was as strongly associated with depression as it was with several of the classic “big five” heart disease risk factors: obesity, high cholesterol, diabetes, high blood pressure, and smoking.
Depression—which for this study, was determined by a checklist of mood symptoms, including anxiety and fatigue—accounted for about 15 percent of cardiovascular and coronary heart disease deaths, and high cholesterol and obesity for 8 to 21 percent. Diabetes posed less of a risk, accounting for 5 to 8 percent of heart-related deaths.
Only two risk factors accounted for more cardiovascular deaths than depression: smoking (between 17 and 20 percent) and high blood pressure (between 30 and 34 percent). Writing in the journal Atherosclerosis, the authors conclude that “depressed mood and exhaustion holds a solid middle position within the concert of major cardiovascular risk factors.”
Mental-health screenings should be standard in patients who have
classic heart disease risk factors, they write, and depression should be
addressed to hopefully prevent additional risk to the heart. Plus, they
add, treating depression is likely to have noticeable, tangible
benefits to patients—something that can’t be said for factors like high
blood pressure or cholesterol.
Heidi May, PhD, a cardiovascular researcher at the
Intermountain Medical Center Heart Institute in Salt Lake City, says
that the new research is “very much in line with what’s currently being
reported by other studies.” May was not involved in the analysis, but
has also studied the link between depression and heart disease.
“There’s a growing recognition for the need to screen
and treat depression, and that doing so can reduce the risk of negative
cardiovascular outcomes,” she says. “This study adds to the research by
looking at specific mood symptoms, so I think it’s a great addition to
what we already know.”
May says that depression likely affects the heart in a
variety of direct and indirect ways. “There are some physiological
changes that take place in the body with depression, and there are also
behavioral changes.” Depressed people are more likely to smoke, exercise
less, and skip their prescribed medication, for example.
For the current study, the results for each variable
were adjusted for all other risk factors—suggesting that depression is
independently linked to heart disease, and is not just a contributor to
Previous research has also shown that this
association is likely a two-way street: Just as depression can
contribute to heart disease, suffering from a serious heart condition
can also lead to depression. And in turn, depression can then impair
That’s why it’s important not only for people with
cardiovascular risk factors to take care of their mental health, says
May, but also for people with depression to take care of their hearts.
“These conditions have a compounding effect,” she says, “and they should
all be treated—whether you have one risk factor or five.”