Depression treatment, increased physical activity in African Americans may reduce heart disease and improve quality of life

Identifying and treating depression, including increasing physical activity, may improve quality of life and reduce cardiovascular disease and death in African Americans, according to reports presented at the American Heart Association’s 2009 Conference on Nutrition, Physical Activity and Metabolism.

In one study, researchers in the Jackson Heart Study (JHS) found high depressive symptoms were prevalent and significantly associated with low physical activity in African Americans. JHS is a population-based, longitudinal study and the largest single-site, prospective, epidemiologic investigation of cardiovascular disease among African Americans ever undertaken.

High depressive symptoms were identified by a standard depression scale and/or characterized by taking antidepressants. Physical activity scores were in the lowest quartile of the JHS Physical Activity Cohort (JPAC) survey for total physical activity, representing the sum of four index scores: active living, work (for those who were employed or did volunteer work), sport and home life.

Of the 3,092 adults (average age 54; 65 percent women; 12 percent smokers), 17 percent had high depressive symptoms. The prevalence of high depressive symptoms was significantly higher among:
• Women (20 percent compared with 10 percent in men);
• Smokers (28 percent compared with 15 percent in nonsmokers); and
• Those with low total physical activity (25 percent vs. 14 percent in higher physical activity). Low physical activity was associated with high depressive symptoms in multivariable logistic regression analysis after controlling for age, sex, body mass index, education, income, and smoking.

“It is important to identify individuals with low levels of physical activity as well as those with depression,” said Patricia Dubbert, Ph.D., lead author of the study and a psychologist with the Veterans Affairs Medical Center in Jackson, Miss. “Both indicate an individual is at greater risk for adverse health outcomes. We have effective interventions to employ when either or both are identified.”

“Behavioral patterns in depressed patients are likely to further negatively impact their cardiovascular disease status,” said Ermeg Akylbekova, M.S., a biostatistician for the Jackson Heart Study. “For example, depressed patients are less likely to exercise, tend to eat in a less healthy manner, and are more likely to use tobacco and alcohol. They are also less likely to take medications as prescribed or closely follow their treatment regimen, which may be a serious impediment to treating their cardiovascular condition.

“It is advisable for healthcare providers treating cardiovascular disease patients, whether cardiologists or primary care, to screen all their patients for depression. If concerns arise, a mental health professional should be consulted. Patients have to be monitored for both conditions.”

A recent American Heart Association science advisory also recommends screening coronary heart disease patients for depression.

Other co-authors are: Thomas Payne, Ph.D.; Sharon Wyatt, Ph.D.; Thomas Mosley, Ph.D.; Mario Sims, Ph.D.; and Herman Taylor, M.D., M.P.H.

(Note: Actual presentation time is 6 p.m. ET, Tuesday, March 10, 2009)

NR09-1034 (NPAM 09/ Akylbekova & Dubbert)

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Abstract P36 – Depressed, older African Americans more likely than whites to die from CVD
Depressed, older African Americans are more likely to die from cardiovascular disease when compared to depressed older whites, researchers reported at the American Heart Association’s 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Researchers examined the association between depression and cardiovascular deaths, fatal ischemic heart disease and stroke deaths in a pool of 6,158 patients, with an average age of 75 years old. Sixty-two percent were black and 61 percent were women.

Researchers measured depressive symptoms using the 10-item Center for Epidemiologic Studies Depression Scale and verified deaths using the National Death Index. After adjusting for a variety of factors — education, smoking, physical activity, blood pressure and body mass index — depressive symptoms were associated with an 11 percent higher risk of cardiovascular disease death in older African Americans, but not in older whites.

Furthermore, older African Americans with depression faced a 10 percent higher risk of dying with ischemic heart disease (restricted blood flow) and a 14 percent higher risk of dying from stroke.
“Additional research on the determinants of the observed black-white differences is warranted,” researchers said. (Note: Actual presentation time is 8:55 a.m. ET, Friday, March 13, 2009)

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Abstract P123 – African Americans with cardiovascular disease more prone to depression
Depressive symptoms may be highly prevalent among African Americans with cardiovascular disease even if they’re taking antidepressant drugs, researchers reported at the American Heart Association’s 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Depression is a risk factor for cardiovascular disease and for increased risk of death after a coronary event. Some research indicates that African Americans with depression are less likely to seek treatment than their white counterparts.

Researchers explored the relationship between elevated depressive symptoms (defined based on a commonly used depression scale and/or use of antidepressants) and cardiovascular disease among 3,233 black patients (average age 54; 65 percent women) participating in the Jackson Heart Study.

Of the patients:
• 281 (9 percent) had cardiovascular disease.
• 915 (28 percent) had elevated depressive symptoms.
• Elevated depressive symptoms were significantly more prevalent among those with cardiovascular disease (46 percent) than those without (26 percent).
• Elevated depressive symptoms were present in women almost twice as often as in men in both groups.

Researchers say improved detection and treatment of depression may reduce cardiovascular disease risk and increase longevity in this population.
(Note: Actual presentation time is 6 p.m. ET, Wednesday, March 11, 2009)

Abstract P117 – Depressed teens with low self-image have increased risk of CVD
Teens suffering from depression and a low self-image have higher levels of inflammatory markers — a risk factor for cardiovascular disease, researchers reported at the American Heart Association’s 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

For their study, researchers collected blood from 226 adolescents (average age 14), measured inflammatory markers and analyzed the composition of their fatty acids.

Stearoyl-CoA desatyrase-1, a key enzyme in fatty acid metabolism, was one of the elevated markers in depressed teens. Higher levels of the enzyme are accompanied by a rise in white blood cell counts. Inversely, as scores for self-image dropped, white blood cell counts rose — indicating increased risk of cardiovascular disease.

“Children with high levels of self-rated depression and low levels of self-concept are likely to have high levels of inflammatory markers, important risk factors for cardiovascular disease,” researchers said.

(Note: Actual presentation time is 6 p.m. ET, Wednesday, March 11, 2009)

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