Harvard Medical School Adviser by the Faculty of Harvard Medical School

Q:

My husband recently read an article online about depression and the heart. He said that because I am a 45-year-old woman with depression, I might be at high risk for heart disease. Is this true? Is there any way to lower my risk?

A:

This is an important question because cardiovascular disease (CVD) -- commonly known as heart disease -- is the leading cause of death in women as well as men. Millions of women in the United States have some form of CVD, and many will die from it or suffer a life-altering disability.

Just because you are a woman, though, doesn't mean you are destined for heart problems. Lots of other things contribute to risk, and many of them can be corrected to help prevent heart disease. These include behaviors and conditions such as smoking, poor diet, physical inactivity, high cholesterol, obesity, high blood pressure and diabetes. And while depression isn't on this hit list just yet, your husband is correct that it's likely to be added in the near future.

Even though it's not clear whether depression actually causes heart attack and stroke, scientific research indicates that there is a strong link between the two. Two recent reports that studied middle-aged women demonstrate the relationship between depression and cardiovascular disease.

The first study asked 1,400 women without heart disease to answer questions about their health status and cardiac risk factors, including both personal and family histories. The researchers also asked three questions to assess depression: Do you often feel sad or depressed? Do you often feel helpless? Do you often feel downhearted and blue?

At the end of the study, the researchers found that the women who answered yes to any of the depression questions developed heart disease at a higher rate than those who answered no to all three questions. And, the more yes answers the women gave, the greater their chances of developing the disease.

The second study involved more than 80,000 women ages 54 to 79 with no history of stroke. More than 22 percent of the women were depressed or had been depressed in the past. To see if there was a link between stroke and depression, the researchers recorded the number of strokes that occurred over a six-year period. The scientists found that women with current depression had a 41 percent greater risk of stroke than women who had never been depressed, and women with a history of depression had a 23 percent greater risk.

They also found that women who took antidepressants were at greater risk than women who didn't. But these results do not mean that antidepressants cause stroke. Taking antidepressants may just indicate more severe depression, not that the drugs themselves contribute to stroke. More research is needed before we can be confident about the impact of these drugs on cardiovascular health.

It's clear that there is a link between depression and the heart and circulation. There are many theories about the nature of this link. Depression causes physical changes in the body that pave the way for cardiovascular disease. It also leads to behaviors that put you at greater risk, such as not exercising, not taking your medications properly or not maintaining healthy social connections.

We cannot say for sure, however, why or even if depression definitely increases this risk. More research is needed to fully understand this relationship.

In the meantime, to protect your heart it is important that you talk to your doctor about how to manage risk factors that are in your control -- and the latest evidence suggests this includes depression.

There are several ways to treat depression, including medications, psychotherapy and exercise (which also helps the heart and arteries). If you are not currently being treated, or if your current treatment is not helping, talk to your doctor about a new treatment plan.

On its own, depression is hard to live with, and developing heart disease can only make things worse. With proper treatment, you can lift your spirits and keep your heart happy, too.

(Submit questions to harvard_adviser@hms.harvard.edu.)

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