If signs of depression in patients hospitalized for a heart attack are not recognized and treated, those patients are twice as likely to suffer a reoccurring coronary event.
And with depression rates in those patients as much as three times greater than the general population, much can be done to improve those patients’ quality of life and ultimately cut down on future health care bills.
Lorraine Frazier, Ph.D., R.N., dean of the UAMS College of Nursing, is conducting a five-year, $2.3 million National Institutes of Health-funded study with a team of former colleagues at the University of Texas Health Science Center at Houston School of Nursing, where she previously worked and taught.
The study focuses on depression and heart disease, and the role genetics plays in the link. In heart disease patients, it’s known that some have physiological changes in their inflammatory proteins when they are depressed. This change in these protein levels, although present throughout their lives in response to depression, becomes problematic as they develop heart disease.
It may be that these individuals require a combination of behavioral therapy and medication.Lorraine Frazier, Ph.D., R.N.
“When you’re older and you have vulnerable plaque in your coronary system, increased levels of inflammatory protein that can be initiated by depression can actually cause these plaques to rupture and result in a heart attack,” Frazier said. “So we’re looking to see if there’s a genetic propensity to those inflammatory protein levels in that group.”
Frazier is looking at data from 1,200 patients who gave blood samples immediately upon entering the hospital because of a heart attack. When the patients are stable, depression and demographic data are also collected.
“We are examining the interaction of the inflammatory protein levels, genetic variations in those proteins, and depression data to determine which patients have a genetic predisposition to increased inflammatory protein levels when depressed,” Frazier said.
“Different interventional approaches for depression may be necessary for this group. It may be that these individuals require a combination of behavioral therapy and medication to effectively treat depressive episodes.”
Even more important, Frazier said, is that those patients be mindful of the potential for depression that may impact their cardiac health.
“It is important that we identify and treat depression in this group because, if not treated, they are more susceptible to subsequent cardiac events,” she said.
The research team is working with individuals who have been diagnosed with heart disease to test if behavioral interventions for depression impact inflammatory protein levels.
“Our challenge is putting people in the best environment to support their health,” Frazier said. “There is great value in finding these people, educating them, and then challenging them to make changes in their environment that enable them to support a healthy lifestyle.”
Sleep disturbance, which Frazier found in all cases of younger depressed female patients, is not a traditional cardiovascular risk factor, but the study suggests that symptoms of sleep disturbance are associated with cardiovascular disease. Frazier and her team are evaluating the impact of sleep symptom screening and sleep disturbance management.
“Screening for symptoms of sleep disturbances may need to be particularly aggressive in women with cardiovascular disease with or without additional symptoms of depression,” Frazier said. “Young women with sleep disturbances may also represent a particularly vulnerable group.”