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INFLUENCE OF SOCIAL SUPPORT AND DEPRESSION ON WOMEN'S CORONARY ATHEROSCLEROSIS PROGRESSION | |
| Contact: Kristina Orth-Gomér, MD and Huixin Wang, PhD
Karolinska Institutet, Stockholm
Box 220, 171 77 Stockholm
Phone: (46 - 8 - 5248 6012) Email: k.orth-gomer.phs.ki.se Embargoed until: March 5, 2004 |
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Coronary Heart Disease (CHD) is the leading cause of death in European countries as in the United States. It is almost as common in women as in men, but it occurs about ten years later in women's lives. In Swedish men, heart disease is the number one cause of disability and ill health, in Swedish women it is ranked as second among diseases which cause suffering and impaired quality of life, only preceded by psychiatric illness, most importantly, depression. In addition, major depressive symptoms, which are found in 20 - 30 % of cardiac patients (almost twice as often in women as in men), significantly increase the mortality risk after an acute myocardial infarction (AMI). It is also known that depression and depressive symptoms are associated with social isolation, and that conversely, high levels of social support predict improvement of depressive symptoms in post AMI patients. It is still under debate, however, whether depression and depressive feelings are cause or consequence of a potentially life threatening illness such as CHD. Cardiac symptoms are frequently accompanied by emotional responses, most commonly hopelessness and depression. The Stockholm Female Coronary Risk study is a community based study of three hundred women, aged 65 and under, admitted for acute coronary syndrome in greater Stockholm. When followed for five years, both depression and social isolation were independently related to poor prognosis. Women with both factors had an almost three times higher risk of a recurrent cardiac event during a five year period. Depressive symptoms were much more common in patients than in three hundred healthy, age matched women, suggesting that the disease by itself raises the risk of depression. In an angiographic sub-study we have now examined how these factors impact on the underlying atherosclerotic disease process in the coronary arteries, by means of quantitative coronary angiography (QCA), repeated after three years. QCA is a precise and objective method, previously "reserved" for the documentation of pharmacological effects, such as lipid lowering on heart disease. WE FOUND THE MOST PRONOUNCED EFFECTS IN WOMEN WHO WERE BOTH DEPRESSED AND SOCIALLY ISOLATED. OVER THREE YEARS, THE MEAN RATE OF PROGRESSION WAS CALCULATED AS THE RATE OF LUMINAL NARROWING, AVERAGED OVER TEN PREDEFINED CORONARY SEGMENTS, WHICH WERE CHOSEN TO REPRESENT THE ENTIRE CORONARY TREE. In depressed and socially isolated women the rate increased by 0.20 mm (95% c.l. 0.09;0.3 mm). In women with good social support, whether depressed (x = 0.07mm 95% c.l. 0.06;016) or not depressed, (x = 0. 05 mm, 95% c.l. 0.03:0.17) the luminal diameter change was negligible. The corresponding percent change in mean luminal diameter was 6.1% for depressed and socially isolated women, 2.4% for depressed and socially integrated women and 1.6% for non-depressed, socially integrated women. Controlling for cardiac symptoms and prognostic markers did not substantially alter these results. We conclude that depressive symptoms and social isolation may worsen prognosis via a direct effect on progression of underlying coronary disease. Good social support may act as a buffer, attenuating the harmful effects of depression. | |
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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Vicki White, Managing Editor for Manuscript Production,
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