By Justin Worland
March 10, 2015
TIME Health
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Intense stress and depression in people with coronary heart disease creates a “perfect storm” that can increase the risk of death, according to a new study in the journal Circulation: Cardiovascular Quality and Outcomes.

Overall, patients with both conditions are nearly 50% more likely to die or experience a heart attack as a result of heart disease than those with low stress or depression. The results were most apparent in the first two and a half years after observation began.

“The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health-risk behaviors,” said lead study author Carmela Alcántara, a researcher at Columbia University Medical Center.

The study, which looked at nearly 4,500 adults, expanded on previous research that found that both depression and stress can independently increase the risk of heart disease. The study suggested that some previous research may have misattributed the cause of heart-disease death to stress or depression independently. In reality, the study suggests, the interaction between stress and depression may have led to death rather than either independent factor.

The study traced participants for an average of nearly six years and asked patients to self-report symptoms of depression and stress. Overall, 6.1% of study participants had both high stress and intense symptoms of depression. Only 5.6% of the total sample had high stress alone, and 7.7% had intense symptoms of depression alone.

Researchers said the results suggest that doctors may want to consider additional methods to treat heart disease that include interventions to treat stress and depression.

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