Epidemiology and the physiopathological link between depression and cardiovascular disease

In the future, cardiovascular disease, together with depression, will be one of the leading causes of global disease in the Western World. It is well known that depression is independently associated with a poor prognosis in patients with ischemic heart disease. Epidemiological studies suggest that in patients with coronary artery disease, depression symptoms identify patients with higher risk of adverse cardiovascular outcomes, other studies maintain that depression symptoms might influence the progression of coronary and peripheral atherosclerosis. The defined pathophysiological pathways which link depression and cardiovascular outcomes are not well recognized although various mechanisms have been proposed to explain this association. Beyond traditional cardiovascular risk factors, autonomic nervous system, low grade of inflammation, platelet function, abnormal function of the hypothalamic–pituitary–adrenal axis and genetic factors can adversely impact the endothelium and arterial walls. Consequently, these mechanisms might be crucial factors in promoting and accelerating atherosclerosis and its complications due to plaque rupture and thrombosis. For these reasons, depression symptoms should be considered as a new cardiac risk factor in the general population and in patients with coronary artery disease.