Saturday, May 19, 2007

Coronary Artery Disease: Diabetes and Depression

Diabetes Plus Depression May Raise Mortality in Coronary Artery Disease Patients

Having both type 2 diabetes and depression puts patients with coronary artery disease at greater risk of death over a 4.5-year period than does either condition alone.

The more severe the depressive symptoms were in those patients with both coronary artery disease and diabetes, the greater their risk of death in the follow-up period.

The finding suggests that physicians should screen for and treat depression in their patients with diabetes and heart disease, said Anastasia Georgiades, Ph.D., at the American Psychosomatic Society meeting in Budapest, Hungary.

Having high scores on the Beck Depression Inventory increased the risk of dying during the follow-up period by 20%–30%, compared with those patients who had similar depression scores but without type 2 diabetes, according to the investigators.

Researchers from Duke University, Durham, N.C., compared 325 patients with type 2 diabetes and 582 patients without the disease during hospitalization for a coronary angiography.
Their depression symptoms were rated using the Beck Depression Inventory (BDI). Approximately 25% scored at least 10 on the BDI, indicating depression, Lana Watkins, Ph.D., an investigator in the study, noted in an interview.

During the study's follow-up period of 4.5 years (median, 3 years), there were 135 deaths among the study participants. Among the depressed group of patients, 19% died, compared with 12% of those participants who did not have depression, Dr. Watkins said.

The researchers found statistically significant associations between depressive symptoms and increased mortality and, separately, diabetes and increased mortality.
The highest mortality was among patients with both diabetes and elevated BDI scores.
The researchers did not publicize hazard ratios, however, because they said those statistics would overestimate the risk and could also create anxiety among patients.

“There is some sort of synergistic effect between type 2 diabetes and depression that we don't fully understand,” Dr. Georgiades said in a statement. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.”

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise, and numerous appointments with their doctor,” Dr. Georgiades said in the statement.
“It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk,” she added.

“Regular exercise has been shown to improve depression, too, so that might be an option,” Dr. Watkins noted in an interview. “This could potentially improve depression and diabetes, and might be a good first choice for diabetics who would prefer not having to take additional medications.”

Cardiology News, Volume 5, Issue 4, Page 20 (April 2007)

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