Bidirectional interaction between depression and cardiovascular disease
DOI:
https://doi.org/10.5281/zenodo.15075621Keywords:
Depression, Cardiovascular diseases, Bidirectional relationship, Risk factorsAbstract
This study aimed to explore the pathophysiological mechanisms and clinical implications of the bidirectional relationship between depression and cardiovascular diseases (CVD), focusing on the biological, behavioral, and psychosocial factors involved. Through an integrative literature review, prepared in six stages, a search was carried out in the LILACS, MEDLINE, and PubMed databases, using the PEO strategy. Studies published between 2020 and 2024 were included, totaling 13 articles after rigorous screening. The results highlighted that depression was associated with a significant increase in the risk of cardiovascular events, such as acute myocardial infarction and stroke, with hazard ratios (HR) ranging from 1.22 to 1.69. Mechanisms such as systemic inflammation, endothelial dysfunction, and dysregulation of the hypothalamic-pituitary-adrenal axis were identified as mediators of this relationship. In parallel, individuals with CVD were more likely to develop depression, especially due to the psychosocial impact of the disease. Gender and age differences were striking, with women and young adults (<65 years) showing greater vulnerability. Shared genetic factors and risk behaviors (sedentary lifestyle, smoking) amplified the bidirectional relationship. Therefore, the relationship between depression and CVD is bidirectional and mediated by biological, behavioral, and psychosocial factors, so early identification of depressive symptoms and implementation of integrated prevention and treatment strategies are essential to mitigate risks and improve clinical outcomes. Limitations include the predominance of observational studies and the underrepresentation of rural and low-income populations. Therefore, future research should prioritize longitudinal designs and clinical trials to test personalized interventions.
References
AGUILERA, A. et al. mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE Study. BMJ Open, [s. l.], v. 10, n. 8, p. e034723, 2020. DOI: 10.1136/bmjopen-2019-034723.
ALJUHANI, H. et al. Food habits and associated risk factors of depressed patients with cardiovascular disease. PLoS ONE, [s. l.], v. 17, n. 2, p. 1-13, 2022. DOI: 10.1371/journal.pone.0263519.
BARGER, S. D.; STRUVE, G. C. Association of Depression With 10-Year and Lifetime Cardiovascular Disease Risk Among US Adults, National Health and Nutrition Examination Survey, 2005–2018. Preventive Chronic Disease, [s. l.], v. 19, p. e28, 2022. DOI: 10.5888/pcd19.210418.
BONNET, F. et al. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis, [s. l.], v. 178, n. 2, p. 339-344, 2005. DOI: 10.1016/J.ATHEROSCLEROSIS.2004.08.035.
CHAPLIN, A. B. et al. Longitudinal association between cardiovascular risk factors and depression in young people: a systematic review and meta-analysis of cohort studies. Psychological Medicine, [s. l.], v. 53, n. 3, p. 1049-1059, 2021. DOI: 10.1017/S0033291721002488.
CHEN, X. et al. Depression Status, Lifestyle, and Metabolic Factors With Subsequent Risk for Major Cardiovascular Events: The China Cardiometabolic Disease and Cancer Cohort (4C) Study. Frontiers in Cardiovascular Medicine, [s. l.], v. 9, p. 865063, 2022. DOI: 10.3389/fcvm.2022.865063.
DRIVA, S. et al. The Effect of Smoking Cessation on Body Weight and Other Metabolic Parameters with Focus on People with Type 2 Diabetes Mellitus. International Journal of Environmental Research and Public Health, [s. l.], v. 19, n. 20, p. 13222, 2022. DOI: 10.3390/ijerph192013222.
ESLER, M. Mental stress and human cardiovascular disease. Neuroscience & Biobehavioral Reviews, [s. l.], v. 74, p. 269-276, 2017. DOI: 10.1016/j.neubiorev.2016.10.011.
FRĄK, W. et al. Pathophysiology of cardiovascular diseases: New insights into molecular mechanisms of atherosclerosis, arterial hypertension, and coronary artery disease. Biomedicines, [s. l.], v. 10, n. 8, p. 1-17, 2022. DOI: 10.3390/biomedicines10081938.
GÓMEZ-GÓMEZ, I. et al. Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: Systematic review and meta-analysis. Preventive Medicine, [s. l.], v. 134, p. 106067, 2020. DOI: 10.1016/j.ypmed.2020.106067.
HARSHFIELD, E. L. et al. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA, [s. l.], v. 324, n. 23, p. 2396-2405, 2020. DOI: 10.1001/jama.2020.23068.
HENEIN, M. et al. The impact of mental stress on cardiovascular health—Part II. Journal of Clinical Medicine, [s. l.], v. 11, n. 15, p. 1-17, 2022. DOI: 10.3390/jcm11154405.
HU, X. et al. Effect of a multidisciplinary supportive program for family caregivers of patients with heart failure on caregiver burden, quality of life, and depression: A randomized controlled study. International Journal of Nursing Studies, [s. l.], v. 62, p. 11-21, 2016.DOI: 10.1016/j.ijnurstu.2016.07.006.
KANG, S. et al. Association between depressive symptoms and cardiovascular diseases in the Korean geriatric population: A nationwide retrospective cohort study. Journal of Affective Disorders, [s. l.], v. 361, p. 182-188, 2024. DOI: 10.1016/j.jad.2024.06.022.
KWAPONG, Y. A. et al. Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States. Journal of the American Heart Association, [s. l.], v. 12, n. 3, p. e028332, 2023. DOI: 10.1161/JAHA.122.028332.
LETT, H. et al. Depression as a risk factor for coronary artery disease: Evidence, mechanisms, and treatment. Psychosomatic Medicine, [s. l.], v. 66, n. 2, p. 305-315, 2004. DOI: 10.1097/01.PSY.0000126207.43307.C0.
LI, G. H. Y. et al. Evaluation of bi-directional causal association between depression and cardiovascular diseases: a Mendelian randomization study. Psychological Medicine, [s. l.], v. 52, n. 9, p. 1765-1776, 2022. DOI: 10.1017/S0033291720003566.
LI, H. et al. Association of depressive symptoms with incident cardiovascular diseases in middle-aged and older Chinese adults. JAMA Network Open, [s. l.], v. 2, n. 12, p. e1916591, 2019. DOI: 10.1001/jamanetworkopen.2019.16591.
LOPIZZO, N. et al. Gene-environment interaction in major depression: focus on experience-dependent biological systems. Frontiers in Psychiatry, [s. l.], v. 6, p. 68, 2015. DOI: 10.3389/fpsyt.2015.00068.
LU, Y. et al. Genetic Liability to Depression and Risk of Coronary Artery Disease, Myocardial Infarction, and Other Cardiovascular Outcomes. Journal of the American Heart Association, [s. l.], v. 10, n. 1, p. e017986, 2020. DOI: 10.1161/JAHA.120.017986.
MENG, R. et al. Association between Depression and All-cause and Cardiovascular Mortality in Chinese Adults. JAMA Network Open, [s. l.], v. 3, n. 2, p. e1921043, 2020. DOI: 10.1001/jamanetworkopen.2019.21043.
MOUTON, A. M. et al. Obesity, Hypertension, and Cardiac Dysfunction: Novel Roles of Immunometabolism in Macrophage Activation and Inflammation. Circulation Research, [s. l.], v. 126, n. 6, p. 789-806, 2020. DOI: 10.1161/CIRCRESAHA.119.312321.
OGUNMOROTI, O. et al. A systematic review of the bidirectional relationship between depressive symptoms and cardiovascular health. Preventive Medicine, [s. l.], v. 154, p. 106891, 2021. DOI: 10.1016/j.ypmed.2021.106891.
PENNINX, B. Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms. Neuroscience & Biobehavioral Reviews, [s. l.], v. 74, p. 277-286, 2017. DOI: 10.1016/j.neubiorev.2016.07.003.
RAFANELLI, C. et al. Sequential combination of cognitive-behavioral treatment and well-being therapy in depressed patients with acute coronary syndromes: A randomized controlled trial (TREATED-ACS study). Psychotherapy and Psychosomatics, [s. l.], v. 89, p. 345-356, 2020. DOI: 10.1159/000510006.
RIERA-SAMPOL, A. et al. Association between Depression, Lifestyles, Sleep Quality, and Sense of Coherence in a Population with Cardiovascular Risk. Nutrients, [s. l.], v. 13, n. 2, p. 585, 2021. DOI: 10.3390/nu13020585.
SHEN, R. et al. Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: Data from the 2005–2018 National Health and Nutrition Examination Survey. Frontiers in Cardiovascular Medicine, [s. l.], v. 9, p. 954563, 2022. DOI: 10.3389/fcvm.2022.954563.
STRINGARIS, A. Editorial: What is depression?. Journal of Child Psychology and Psychiatry, [s. l.], v. 58, n. 12, p. 1287-1289, 2017. DOI: 10.1111/jcpp.12844.
TANG, A.; THOMAS, S. Relationships between depressive symptoms, other psychological symptoms, and quality of life. Psychiatry Research, [s. l.], v. 289, 2020. DOI: 10.1016/j.psychres.2020.113049.
THAKUR, B. et al. Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States. American Journal of Health Promotion, [s. l.], v. 38, n. 8, p. 1199-1209, 2024. DOI: 10.1177/08901171241262249.
TORGERSEN, K. et al. Shared genetic loci between depression and cardiometabolic traits. PLoS Genetics, [s. l.], v. 18, n. 5, p. e1010161, 2022. DOI: 10.1371/journal.pgen.1010161.
YU, L. et al. Association Between Depression and Risk of Incident Cardiovascular Diseases and Its Sex and Age Modifications: A Prospective Cohort Study in Southwest China. Frontiers in Public Health, [s. l.], v. 10, p. 765183, 2022. DOI: 10.3389/fpubh.2022.765183.
ZAJKOWSKA, Z. et al. A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression. Journal of Psychiatric Research, [s. l.], v. 138, p. 163-175, 2021. DOI: 10.1016/j.jpsychires.2021.04.003.
WARD, A. Symptoms of depression: Charles G. Costello (Ed.): Wiley, New York (1993). x + 326 pp. £29.95. Behaviour Research and Therapy, [s. l.], v. 33, n. 5, p. 615, 1995. DOI: 10.1016/0005-7967(95)90121-3.
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