Today, there is practically no doubt that human health is closely related to environmental factors. According to the prevailing view, cardiovascular disease (CVD) is caused by several chronic pathological processes resulting from a complex interaction between genetic predisposition and environmental and lifestyle factors. They lead to a progressive disruption of the structure and functioning of tissues and cells of the cardiovascular system. Although the specific contribution of individual elements, in particular genetics and environmental factors, remains poorly understood, it is believed that environmental and lifestyle factors play a dominant role in the development of CVD.
Effects of Stress on the Cardiovascular System
Cardiovascular diseases (CVD) and depressive disorders are among the most common conditions that reduce the ability to work and lead to disability. Their combination is a well-known fact in clinical practice and has been confirmed by numerous population-based studies: for example, Jha et al. (2019) said Depression is a major cause of morbidity and poor quality of life in patients with cardiovascular disease (1829). The continued psychological tension in which people live in a large city makes them feel constant stress (Teleki et al., 2022). In people’s minds, stress correlates with fatigue, irritability, anxiety, and even unmotivated hatred and aggression towards others.
Stress releases a large number of hormones and mediators. Such a hormonal surge leads to the activation of all body systems, an increase in heart rate, an increase in blood pressure and body temperature, and a rush of blood to the muscles which is confirmed by Dhabhar’s (2018) research. If the body’s reserves do not allow it to adapt to the changed conditions, a phase of exhaustion can be fertile ground for cardiovascular diseases. First, arterial hypertension can damage the heart muscle and other target organs, including brain (Kućmierz et al., 2021). Ultimately, the inability to cope with psycho-emotional stress can lead to stroke and myocardial infarction.
Prevalence of Depression in Cardiovascular Pathology
According to Gorini et al. (2020), the prevalence of depressive conditions in patients with CVD ranges from 15 to 30% (1). However, since epidemiological studies use different methodological approaches and diagnostic criteria for depression, their results are often difficult to compare. In a long-term controlled study by Wang et al. (2021), it has been established that in people with depression, the risk of coronary heart disease (CHD) and myocardial infarction (MI) is almost twice as high (2). Among patients with CVD, the proportion of patients suffering from depressive disorders is significantly higher than in other forms of somatic pathology (Wang et al., 2021). It greatly exceeds the prevalence of depression among the population.
Numerous studies confirm the important role of subclinical inflammation in the pathogenesis of cardiac diseases in general and coronary artery disease in particular. Inflammatory cytokines are involved in the formation and destruction of atherosclerotic plaques, which is the main link in the pathogenesis of CAD (Arida et al., 2018). Inflammation plays a key role in the pathogenesis of certain types of CHF (Arida et al., 2018). The results of studies published by US National Heart, Lung, and Blood Institute (NHLBI) suggest that the inflammatory process, in combination with severe depressive symptoms or major depressive disorder (MDD), is associated with cardiovascular morbidity and mortality.
Treatment of Depression Due to Cardiovascular Diseases
Thus, depression and chronic diseases have a bidirectional relationship in which they potentiate each other through a feedback mechanism. Therefore, timely detection of depression is necessary to prevent and treat cardiovascular pathology. First of all, Mailloux et al. (2020) recommend to screen for depression among patients who have had a myocardial infarction and stroke (12). Adequate treatment and psychological assistance for patients with depression are essential as well. Given the above, it can be assumed that timely treatment of depression will improve the course and prognosis of cardiovascular diseases.
Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice in the treatment of depression in patients with cardiovascular disease. According to the recommendations of the working group of (NHLBI), patients treated with antidepressants had a lower risk of developing myocardial ischemia induced by mental stress than the rest of the observed (Moazzami et al., 2020). Moreover, this association between antidepressant use and a lower risk of myocardial ischemia persisted after adjusting for risk factors such as a history of depression or depressive symptoms at the time of the study.
Against the background of taking SSRIs, in comparison with tricyclic antidepressants, strokes occur significantly less frequently. Jang et al. (2020), in their study, found a high risk of developing myocardial infarction in the first months after the appointment of antidepressants (3). The increase in the risk of death from all causes and the risk of death from cardiovascular diseases when taking tricyclic antidepressants, the authors explain the side effects of these drugs and their proarrhythmic effect.
The analysis results suggest that the presence of depressive symptoms is associated with an increased risk of cardiovascular disease in the future. Data from numerous experimental and clinical studies indicate a close relationship between the human environment that causes stress and CVD. One of the ways to improve the detection and treatment of depression in cardiac patients is through joint medical programs with the participation of psychiatrists and psychotherapists.
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Jang, H. Y., Kim, J. H., Song, Y.-K., Shin, J.-Y., Lee, H.-Y., Ahn, Y. M., Oh, J. M., & Kim, I.-W. (2020). Antidepressant use and the risk of major adverse cardiovascular events in patients without known cardiovascular disease: A retrospective cohort study. Frontiers in Pharmacology, 11. Web.
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