Lethal combination: depression and heart disease

September 16, 2010 by  
Filed under DEPRESSION, HEART AND STROKE

Heart disease is a serious physical disorder. Depression is a serious neurological disorder. The two together makes a dangerous combination that is more lethal that when these disorders exist alone. This is according to a recent report in the journal Heart.

It has been shown before that there is a strong link between depressions and poor heart health. Depressed people are very likely to develop coronary heart disease. The study was based on data from the British Whitehall II study which followed up more than 10,000 civil servants. The substudy tracked almost 6000 middle aged adults for an average of 5.5 years.

The incidence of depression was significantly higher in those with established heart disease (20%) than among those without heart problems (14%). During the follow-up period, 170 study participants died, and 47 of these deaths were due to a cardiovascular event such as stroke or heart attack.

What is interesting is that depression seems to increase overall mortality risk even more than heart disease.

“Those with coronary heart disease alone were 67% more likely to die of all causes, while those who were depressed, but otherwise healthy, were twice as likely to do so as those who had neither condition.”

When heart disease and depression co-occur, the likelihood of death increases 5 times. Even after correction for other confounding factors, the mortality risk of those with the heart disease-depression combo is still 3 to 4 times higher than those who are healthy.

The link between depression and heart disease is not clearly understood. The authors postulate:

The biological explanations for the impact of depression on the risk of death are still not clear… but may involve stimulating the inflammatory process and/or clot formation, or altering cellular responses and/or the metabolism of blood fats. Behavioural factors might also play a part.

Is it a case of mind over matter? Or mind over heart? In any case, health care professionals are advised to pay more attention and watch for depressive symptoms in their cardiac patients. And psychistriatrists should do the vice versa in their depressive patients.

High altitude = low CV risk

November 11, 2009 by  
Filed under HEART AND STROKE

matterhornNow, here is one situation wherein being “high” is actually good for your health. Literary speaking.

Swiss researchers report that people who were born and lived in higher altitudes have a much lower risk of dying from cardiovascular diseases than people born and bred in the low lands.

Switzerland is the ideal place where this kind of study can be conducted since a large portion of this little country is mountainous. The researchers looked specifically at the inhabitants of German-speaking part of Switzerland, a group which is more or less homogenous ethnically and culturally and with regards to access to healthcare. The study covered areas with altitudes from 259 to 1960 m above sea level. By looking at data on sociodemographic, birth-location, current residency, and mortality rates, the researchers were able to analyze how altitude is related to health. The results of the analysis showed that

  • An altitude difference of 1000 m was associated with a relative risk reduction in cardiovascular mortality of 22%.
  • The same altitude difference was associated with a risk reduction of 12% in stroke.

It seems that people who were born and lived up in the mountains have some protective benefits from this geographic location, a benefit which they retain even if they, at some stage move down to the low lands. However, those who were born in low altitudes do not have this benefit and wouldn’t gain it even if they move up later.

So why are people in higher altitude healthier than those living closer to sea level? Some of the proposed reasons are:

The beneficial effects of altitude seem to be more evident in men than in women, thus pointing again to climate-related factors: men are more likely to work outdoors and eng age in physical labor.

I and my family have been living in Switzerland for the last 3 years. We live in the lower altitudes, though but we try to go up the mountains as often as we can which luckily, are easily available by car, better by public transport or on foot. We were all born in the lowlands so I don’t think our cardiovascular risk factors will be greatly changed by the alpine climate. However, the fresh air and the physical exercise alone in going up the mountains can greatly benefit those who want to give it a try.

It’s not all bad news for rosiglitazone

June 17, 2009 by  
Filed under DIABETES

capsuleRemember the controversy about the diabetic drug rosiglitazone (market name Avandia)? Remember the issues surrounding the APPROACH Trial – Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in Type 2 Diabetes Patients with Cardiovascular History? The drug was thought to increase cardiovascular risk, which brings to mind the problems faced by Vioxx.

Well, it seems that new trials indicate that it is not all bad news about rosiglitazone. In a late-breaking clinical trial using IVUS technology, rosiglitazone was compared with another diabetic drug glipizide. The trial’s primary endpoint, which is “a significant difference in percent atheroma, or plaque, buildup in coronary arteries“, was not met, but it did bring up some good points about rosiglitazone, especially with the secondary end points. The recent results show that:

IVUS stands for intravascular ultrasound and is the world’s largest study of diabetic patients with established coronary artery disease (CAD). The study involved 672 patients from 92 hospitals in 19 countries worldwide. The effect of diabetic drugs on the progression of CAD was assessed using the intravascular ultrasound technique. This was done by measuring the plaque burden using IVUS in a 40 mm segment of an atherosclerotic artery which hasn’t undergone any intervention because level of plaque build up was considered to be too low to require treatment.

People suffering from diabetes have increased risks for atherosclerosis, heart attack, stroke, and other cardiovascular disorders. Diabetes a metabolic disorder which interferes with blood sugar metabolism due to problems with insulin, the hormone produced by pancreas needed to metabolize glucose in the blood.

About the two drugs:

Rosiglitazone is a member of the thiazolidinedione class of diabetes drugs. It works by making the cells of the body more sensitive to insulin. In addition, the drug also has a positive impact on blood pressure, high density lipoprotein (HDL “good”) cholesterol and has anti-inflammatory properties. However, in 2007, the US FDA issued warnings about rosiglitazone increasing risk of cardiac events.

In a more recent report, the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial reports that rosiglitazone “does not increase overall cardiovascular risk.

Glipizide belongs to the sulfonylurea class of insulin secretagogues. It works by inducing the pancreas to secrete more insulin. It has been on the market for more than 40 years.

Photo credit: stock.xchng

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.