Cardiac disease and depression; a direct association?

At the April meeting of EuroHeartCare 2016 (Athens, Greece), Dr. Barbro Kjellström (Karolinska Institute Stockholm, Sweden) showed that patients with a sustained myocardial infarction (MI) are more depressed but are less often prescribed antidepressants than people without a sustained MI. EuroHeartCare is the annual congress of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC). The data presented at EuroHeartCare were derived from the Swedish PAROKRANK study showing that periodontitis increased the risk of having a first MI by 30% [1, 2]. The study included 805 patients under 75 years (average 62 years, 81% men) who had experienced a first MI. Symptoms of depression were found in 14% of patients compared with only 7% of 805 matched controls, and these symptoms were associated with a doubled risk for an MI. A novel and intriguing finding was that MI patients less often received treatment for depression: only 16% of the MI patients with depression received antidepressants compared with 42% of controls with depression. These results suggest that MI patients are undertreated with antidepressants, possibly because they did not seek help for their depression, or if they did, their symptoms were not accurately recognised and managed. According to the presenters of the study, clinicians should question MI patients more explicitly about their mental well-being and carefully listen to their reply.