Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation
Open accessAbstract
Major depression is a highly prevalent condition, affecting approximately 10% of the population. It is also a growing global problem, and has been consistently associated with increased risk of coronary heart disease (CHD). It is therefore not surprising that depression is highly comorbid with CHD, being two to three times more common among patients with CHD than in the general population. The prevalence of depression is 15–30% in patients with CHD, and is approximately twice as high in women than men, especially affecting young women in the aftermath of acute myocardial infarction (MI). Depression as a risk factor for CHD has been characterized from mild depressive symptoms to a clinical diagnosis of major depression. As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), clinical depression, or major depression, is characterized by depressed mood or anhedonia (loss of interest or pleasure) for at least 2 weeks accompanied by significant functional impairment and additional somatic or cognitive symptoms. Most epidemiological studies of depression and incidence of CHD have used depressive symptom scales, and have frequently demonstrated a dose–response pattern, with higher levels of depressive symptoms being associated with higher risk. The exact mechanisms linking depression to increased CHD risk are complex and multifactorial, and still incompletely understood. Although adverse lifestyle behaviours and traditional CHD risk factors, such as smoking and sedentary lifestyle, largely contribute to the risk, they do not explain it entirely. In CHD patients, depression is also associated with severity of functional impairment, lower adherence to therapy and lower participation in cardiac rehabilitation. Whether and to what extent these factors explain the relationship between depression and CHD deserves future study. The present paper summarizes key aspects in our current knowledge linking depression and CHD within the intersecting fields of neuroscience, cardiovascular physiology, and behavioural medicine, with the objective of bringing attention to this area and stimulating interdisciplinary research, clinical awareness, and improved care.
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There is an absence of treatment for patients who screen positive for depression and anxiety, as screening combined with treatment is far from universally implemented.
“There is an absence of treatment for patients who screen positive for depression and anxiety, as screening for depression and anxiety in patients with IHD combined with treatment are far from universally implemented [20].”
From Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol (2021) · cites this paper as [20]
The ‘Recognition and screening’ section says depression is often unrecognized and untreated in coronary heart disease patients and that there is no consensus on making screening and treatment routine in cardiology practice. It does not establish a lack of treatment specifically among patients who screen positive, or make the same claim about anxiety. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn people with cardiovascular diseases and stroke survivors, MDD is associated with increased risk of atrial fibrillation and chest pain.
“In people with cardiovascular diseases and stroke survivors, MDD is associated with increased health care costs and unplanned rehospitalizations23,25, an increased risk of atrial fibrillation and chest pain2, and a significant decrease in quality of life45,46.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [2]
The sections on atrial fibrillation and chest pain associate depression with AF and with increased chest-pain reporting in patients with established coronary heart disease. They do not establish these associations specifically in stroke survivors, and the cited passages discuss depression rather than consistently limiting the findings to major depressive disorder (MDD). (LLM, conf=0.85)
Experimental — accuracy not yet measuredScreening combined with treatment of patients' distress is far from universally implemented.
“The Danish situation is not unique, as screening combined with treatment of patients’ distress is far from universally implemented [20].”
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“sodes that do not respond to standard treatments have also been identified as high-risk subtypes.(35) However, evidence suggests that recognition and treatment of depression improves prognosis.”
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“Depression has been associated with an almost three-fold increase in the odds of the reoccurrence of AF after successful electric cardioversion,(65) and negative emotions have been shown to trigger AF episodes in persons with paroxysmal AF.(66) Furthermore, negative life events like the death of a partner have been as…”
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- Authors
- Vaccarino, V., Badimon, L., Bremner, J. D., Cenko, E., Cubedo, J., Dorobantu, M., Duncker, D. J., Koller, A., Manfrini, O., Milicic, D., Padro, T., Pries, A. R., Quyyumi, A. A., Tousoulis, D., Trifunovic, D., Vasiljevic, Z., de Wit, C., Bugiardini, R., ESC Scientific Document Group Reviewers, Lancellotti, P., & Carneiro, A. V.
- Affiliations
- Emory University (US)
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau. CiberCV-Institute Carlos III. Autonomous University of Barcelona , C/ Sant Antoni Maria Claret, 167, 08025, Barcelona,
- University of Bologna (IT)
- Universitat Autònoma de Barcelona (ES)
- Cardiology Department, University of Medicine and Pharmacy ‘Carol Davila’ of Bucharest, Emergency Clinical Hospital of Bucharest , Calea Floreasca 8, Sector 1, Bucuresti, 014461,
- Erasmus MC (NL)
- Institute of Natural Sciences, University of Physical Education , Alkotas street, 44, 1123, Budapest,
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb , Kispaticeva 12, HR-10000, Zagreb,
- Charité – Universitätsmedizin Berlin (DE)
- National and Kapodistrian University of Athens (GR)
- Department of Cardiology, University Clinical Center of Serbia , Pasterova 2, 11000, Belgrade,
- School of Medicine, University of Belgrade , Dr Subotica 8, 11000, Belgrade,
- Institut für Physiologie, Universität zu Lübeck and Deutsches Zentrumfür Herz-Kreislauf-Forschung (DZHK) , Ratzeburger Allee 160, 23538, Lübeck,
- University of Liège (BE)
- University of Lisbon (PT)
- Corresponding author
- Bugiardini, Raffaele
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-01-28
- Volume
- 41
- Issue
- 17
- Pages
- 1687-1696
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC10941327
- OpenAlex
- W2912703574
- Cited by
- 404
- References
- 247
- Citations by year
- 2026: 41 · 2025: 67 · 2024: 63 · 2023: 49 · 2022: 71 · 2021: 48 · 2020: 43 · 2019: 21
- FWCI
- 33.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- ORBi (University of Liège) (submittedVersion, other-oa)
- Touro Scholar (Touro College) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
- Funders
- NIH
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- major depressive disorder, coronary artery disease, comorbidities, cardiovascular risk factors, depressive symptoms, myocardial infarction, cardiac rehabilitation, medication adherence, lifestyle habits, sex differences, microcirculation, anhedonia
- MeSH terms
- Coronary Circulation, Coronary Disease, Depression, Heart, Humans, Microcirculation
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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