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Study finds earlier depression treatment prevents heart attacks and strokes


INDIANAPOLIS — Lifestyle changes such as stopping smoking and reducing high cholesterol and blood pressure have long been known as ways to prevent heart attacks and stroke, but researchers have discovered a new preventative measure — earlier treatment for depression.

Treatment of depression before any apparent signs of cardiovascular disease can decrease the risk of heart attacks and strokes by almost half, according to the study “Effect of Collaborative Care for Depression on Risk of Cardiovascular Events: Data from the IMPACT Randomized Controlled Trial,” which appears in the January 2014 issue of Psychosomatic Medicine.

The study was conducted by Jesse C. Stewart, Ph.D., an associate professor of psychology in the School of Science at Indiana University-Purdue University Indianapolis, and biostatistician Anthony Perkins, M.S., and geriatrician Christopher Callahan, M.D., with the Indiana University Center for Aging Research.

“Previous studies we and others have conducted indicate that depression is a risk factor for cardiovascular disease.  But past depression treatment studies involving cardiac patients have not shown the anticipated cardiovascular benefits.  So we asked ourselves, what if we treated depression before the onset of cardiovascular disease?  Could that cut the risk of heart attack and stroke?  Our results suggest that the answer is yes,” said Dr. Stewart, who is an affiliated scientist with the IU Center for Aging Research.

The researchers followed 235 older, clinically depressed patients who were randomly assigned to standard care or to a collaborative care program involving antidepressants and psychotherapy. Among the 168 patients with no cardiovascular disease at the start of the study, those who received collaborative care to treat their depression had a 48 percent lower risk of heart attack or stroke over the next 8 years than did patients who received standard care for their depression.

In contrast, collaborative care was not associated with a lower risk of a heart attack or stroke among the 67 patients with preexisting cardiovascular disease. 

These findings suggest that depression treatment may need to be initiated before the onset of cardiovascular disease if cardiovascular benefits are desired.

“Lifestyle changes are important approaches to decreasing risk of heart attacks and strokes. Our findings, if confirmed in a larger clinical trial, could provide an important new approach – depression treatment – to preventing cardiovascular events,” said Dr. Stewart.

He and his collaborators are seeking funding to conduct a larger randomized controlled trial to verify that treating depression earlier in the natural history of cardiovascular disease reduces the risk of heart attacks and strokes.

Depression affects more than 6.5 million Americans age 65 years or older, according to the National Alliance on Mental Health.

“In the near future depression treatment may play an important role in reducing disability and death due to cardiovascular disease,” said Dr. Stewart.

Co-author Dr. Callahan is founding director of the IU Center for Aging Research, director of aging research and a research scientist at the Regenstrief Institute, and the Cornelius and Yvonne Pettinga Professor in Aging Research at the Indiana University School of Medicine.

This work was supported by the National Institute on Aging (AG031222 and AG024078), part of the National Institutes of Health. The content of the study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.