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3 - Depression and the development of coronary heart disease

from Part 2 - Depression and specific health problems

Published online by Cambridge University Press:  17 September 2009

By
Andrew Steptoe
Edited by
Andrew Steptoe
Andrew Steptoe
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
Andrew Steptoe
Affiliation:
University College London
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Summary

Introduction

This chapter is concerned with the role of depression in the development of coronary atherosclerosis and in the aetiology of coronary heart disease (CHD). Chapter 4 discusses the association between depression and prognosis in patients with existing CHD. The relationship of depression with cardiovascular disease has been a topic of intense research interest over the past 15 years and has driven much contemporary thinking about how physical illness and depression are linked. It has stimulated work on a variety of biological processes that potentially mediate the relationship, including platelet activation [1], vascular inflammation [2], endothelial dysfunction [3], reduced baroreceptor reflex sensitivity [4], sympathovagal imbalance [5] and neuroendocrine dysfunction [6].

The purpose of this chapter is to evaluate the strength and consistency of the association between depression and future CHD, to evaluate the specificity of the relationship, and to describe the biological processes that are probably involved. The chapter is divided into five sections. The first section provides a critical review of existing evidence from longitudinal observational studies that depression and depressive symptoms are associated prospectively with CHD in initially healthy adults. Studies of this topic have generated rather variable results, and so it is worth considering what accounts for the discrepancies. The chapter then questions whether there is a specific link between depression and CHD, or whether comparable associations are present for anxiety and more general psychological distress.

Keywords

acute haemostatic responsecomputed tomographycoronary artery calcificationcoronary atherosclerosisintima-medial layerpsychological stresscoronary heart diseasedepression
Type
Chapter
Information
Depression and Physical Illness , pp. 53 - 86
Publisher: Cambridge University Press
Print publication year: 2006

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