Conference: Depression and social isolation are independent risk factors for heart disease and also influence its prognosis, a major international conference has been told.
In the case of mild depression, there is a two-fold increase in the risk of coronary heart disease, rising to a five-fold increase in the incidence of angina and heart attacks in people with major depression.
Dr Stephen Bunker of the National Heart Foundation of Australia told health professionals attending the 8th World Congress of Cardiac Rehabilitation and Secondary Prevention in Dublin yesterday there was "strong and consistent evidence of a causal association between depression, social isolation and lack of quality social support and coronary heart disease".
The increased risk posed by these psychosocial factors was "of a similar order" to more conventional risk factors such as smoking and cholesterol, he said.
Dr Bunker called for these risks to be taken into account when individual patients were being assessed. "The implications of our finding are that the medical community needs to be more aware of factors such as depression and social isolation and that they are of a similar magnitude to cholesterol and high blood pressure.
"Patients with coronary heart disease should be assessed for depression and patients with depression should be assessed for coronary heart disease risk factors," he told The Irish Times.
However, the Australian research found no consistent evidence linking heart disease with type A personality or anxiety disorders. Nor was there an association with work-related stress.
Dr Emer Shelley, national heart health adviser with the Department of Health, told the conference of the successes of the Republic's 1999 National Cardiovascular Strategy. "There is now a large body of evidence to show that interventions to reduce mortality from cardiovascular disease are working," she said.
Asked about the progress being made in cardiac prevention during the Republic's Presidency of the EU, Dr Shelley said she expected to see agreement next month on a range of issues aimed at implementing standard interventions for both high risk groups and those at average risk for heart disease.
She told The Irish Times a major challenge here would be to extend the benefits of heart disease prevention to those who are less well off.
"Everyone in the health service is concerned about this. A lot of it comes down to socioeconomics. Ireland Inc is doing well economically; the challenge is to turn this into a social gain for all our people," she said.
Dr Shelley also signalled work was already underway in developing a new cardiovascular strategy. "We need to look at the quality agenda and to look at some newer treatments which did not exist when the current strategy was formulated."