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Gender Differences in the Link Between Depression and Cardiovascular Disease

From the Division of Cardiology (T.Z.N., N.B.M.), Department of Medicine and the Department of Psychiatry (S.S.A.N.), Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, University of California School of Medicine, Los Angeles, California.

Address correspondence and reprint requests to Tasneem Z. Naqvi, MD, Rm. 5341, Division of Cardiology, 8700 Beverly Blvd., Los Angeles, CA 90048. E-mail: tasneem.naqvi{at}cshs.org

Objectives: Cardiovascular disease is the leading cause of mortality in women costing more than 500,000 lives each year in the United States alone. Major depression in healthy subjects increases cardiovascular mortality in both men and women. The presence of major depression in patients with recent acute myocardial infarction (AMI) or unstable angina more than doubles the risk of cardiac death in both men and women. In the presence of depression, lack of social integration has an additive effect on cardiac events. Depression is more prevalent in women with coronary heart disease (CHD) than in men. Psychologic counseling as well as cognitive behavioral treatment in women post-AMI seems to adversely affect prognosis, whereas it has neutral effects in men. Pharmacologic treatment of depression with serotonin reuptake inhibitors is safe in men and women post-AMI and is particularly effective in patients with recurrent depression. Whether effective treatment of depression lowers cardiac mortality remains to be proven.

Key Words: depression • coronary artery disease • gender differences • mortality

Abbreviations: CHD = coronary heart disease; AMI = acute myocardial infarction; SSRIs = serotonin reuptake inhibitors; CABG = coronary artery bypass surgery.

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