The head and the heart of it all
Psychosocial factors such as depression and social isolation can lead to a five-fold increase in the risk of coronary heart disease (CHD).
A review co-authored by the National Heart Foundation's Professor Andrew Tonkin in the current edition of the Medical Journal of Australia reveals that there is strong evidence of an independent causal association between depression, social isolation, lack of quality social support and CHD.
"Until now public health approaches to CHD have focussed largely on modification of conventional risk factors. But there is a need to consider the burden imposed by depression and social isolation on CHD risk factors," says Prof Tonkin.
"The CHD risk is directly related to the severity of depression - a 1-2-fold increase in CHD for minor depression and 3-5 fold increase for major depression.
"In addition, social isolation and lack of quality social support are independent risk factors for CHD onset and prognosis: the risks are increased 2-3-fold and 3-5-fold, respectively.
"The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking and high blood pressure."
This covers men and women in various countries and across many age groups.
The research shows no strong or consistent evidence for a causal association between CHD and chronic life events, work-related stressors, type-A behaviour patters, hostility, anxiety disorders or panic disorders.
Prof Tonkin says depression and CHD frequently coexist and that CHD patients should be assessed for depression and patients with depression assessed for CHD risk factors.
"While attention to these psychosocial factors may improve outcomes in CHD patients, we need more evidence in this area."
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Donna Le Page for Professor Andrew Tonkin on 0412 797 937 donna@lepage-pr.com.au
Judith Tokley AMA 0408 824 306