Relationship Between Depression And Vascular Disease

A frequently replicated neuroimaging finding in depression is an increase in hyperintensities in the white matter and deep gray matter of the basal ganglia. In a large study of more than 3,000 elderly, severity of hyperintensity lesions was significantly associated with depression severity. These signal intensities are due to cerebrovascular disease more commonly in depression.

Further, several studies have consistently found that depression is a risk factor for cardiovascular disease and has a direct impact on cardiovascular mortality following a heart attack (69). Depression is as strong a predictor of poor outcome following an MI as the best-established risk factor, left ventricular dysfunction. Similarly, there is equally compelling evidence that coronary artery disease, stroke, and peripheral vascular disease are all associated with high rates of depression. There is little relationship between hypertension or cholesterol and depression.

Chronic pro-inflammatory cytokine activation is also associated with coronary artery syndromes and thought to mediate the relationship between depression and cardiovascular disease, as well as that between cardiovascular disease and diabetes (70, 71). Specifically, interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) increase hyperglycemia and interfere with lipid metabolism. They are important in the pathogenesis of atherosclerosis. As symptoms of stress increase, so does systemic inflammation, increasing cardiovascular risk (72).

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