Key result
Psychological therapies for depression linked to reduced CVD risk.
Why the study?
It is currently unknown whether positive psychotherapy outcomes for depression are associated with cardiovascular risk reduction.
Does reliable improvement from depression following psychotherapy reduce the risk of incident cardiovascular disease in patients with depression?
Cohort (n=636,955)
Yes
Does reliable improvement from depression following psychotherapy reduce the risk of incident cardiovascular disease in patients with depression?
Hazard Ratio: 0.88 (95% CI 0.86–0.89)
Successful psychological treatment of depression is associated with a significant reduction in the risk of subsequent cardiovascular events and mortality.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study suggests that improving mental health could also help physical health, especially in those aged under 60. People whose depression symptoms improved after therapy had a 10% to 15% lower risk of cardiovascular disease than those who did not improve. Comparable effects were found in similar studies investigating low fat diets.”
“This study provides robust support for an association between reduction in depression after psychological therapy and reduced future risk of cardiovascular disease. The sample is large and very comprehensive, including all the IAPT services in England. This study provides an important piece of the puzzle in understanding the well-established comorbidity between cardiovascular disease and depression, which could help reduce the risk of morbidity and mortality in mental health conditions.”
“This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes. While observational, it provides further evidence that brain and heart health are connected, and that treating depression may have other significant benefits beyond improving mental health.”
No practice change for depression or CVD care; leaves open causality, needing RCTs to test if symptom improvement reduces events.
AIMS: People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. METHODS AND RESULTS: A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses. CONCLUSION: Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.
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Baou et al. (2023) conducted a cohort in Depression (n=636,955). Reliable improvement from depression symptoms vs. No reliable improvement from depression symptoms was evaluated on New onset of any CVD (HR 0.88, 95% CI 0.86-0.89). Reliable improvement from depression symptoms following psychotherapy was associated with a lower risk of new onset of any cardiovascular disease (HR 0.88; 95% CI 0.86-0.89).
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