Depression Increases Risk of Common Arrhythmia

Parveen Garg, M.D., M.P.H

About 16 million American adults experience depression every year according to the Centers for Disease Control and Prevention (CDC). Preliminary research states that those patients may be at higher risk for developing atrial fibrillation, the most common heart rhythm disorder.

"Our findings identify a large portion of Americans who may be at an increased risk for developing atrial fibrillation and who may benefit from more targeted efforts to prevent this arrhythmia," said study lead investigator Parveen Garg, M.D., M.P.H, assistant professor of clinical medicine at the Keck School of Medicine of the University of Southern California in Los Angeles.

Previous research has connected depression to other heart conditions, including a link to increased risk of heart attacks for patients living with HIV, highlighting the need for research into the links between depression and cardiovascular health.

Exactly how depression affects heart health remains unclear, researchers said, but several possibilities have been suggested.

“Depression can induce a variety of changes in the body [by] increasing the levels of inflammation in the body, activating the autonomic nervous system which increases the catecholamine levels in our body, activating the hypothalamic-pituitary-adrenal axis which increases the cortisol levels in our body, and activating the renin-angiotensin-aldosterone system,” Garg told MD Magazine.

This study included 6644 individuals with a mean age of 62. Participants had no known heart disease at the start of the study.

At baseline, depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medication. A CES-D score ≥16 is a value commonly used to identify clinically relevant depression symptoms.

Participants with a CES-D score ≥16 had more than a 34% higher risk of developing atrial fibrillation than participants with CES-D scores <2. Individuals taking anti-depressant medication had a 36% greater likelihood of developing atrial fibrillation compared to those not taking medication for depression.

"Clinicians and patients should be aware that depression has been shown in several studies to be a risk factor for heart disease in general and, in this study, for atrial fibrillation as well," Garg said. "Treating depression is important for many reasons including cardiovascular health."

While previous research has been conducted in predominantly white populations, this study followed a multi-ethnic cohort for a median of 13 years. The 6644 participants were 38% white, 28% black, 22% Hispanic, and 12% Chinese-American. Researchers found that results did not differ by ethnicity.

“An important next step is to confirm these results in other studies, especially those with more comprehensive and clinically validated assessments of depression,” said Garg. “If confirmed, then it will be important to determine if treating individuals with depression actually reduces their risk of [atrial fibrillation].”

The study, “Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis,” was presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018. An abstract is available.