CLINICAL RESEARCH: ENDOTHELIAL DYSFUNCTION
Impaired Endothelial Function in Coronary Heart Disease Patients With Depressive Symptomatology
Andrew Sherwood, PhD*,*,
Alan L. Hinderliter, MD ,
Lana L. Watkins, PhD*,
Robert A. Waugh, MD* and
James A. Blumenthal, PhD*
* Duke University Medical Center, Durham, North Carolina
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Manuscript received January 4, 2005;
revised manuscript received April 4, 2005,
accepted May 27, 2005.
* Reprint requests and correspondence: Dr. Andrew Sherwood, Box 3119, Duke University Medical Center, Durham, North Carolina 27710
(Email: sherw002{at}mc.duke.edu).
OBJECTIVES: The purpose of this study was to assess whether depressive symptomatology was associated with vascular endothelial dysfunction in patients with coronary heart disease (CHD).
BACKGROUND: In patients with CHD, the presence of depression is associated with a two to four times increased risk of mortality, but the disease pathways involved are uncertain. Endothelial dysfunction is an established risk factor for cardiovascular events in patients with CHD.
METHODS: Flow-mediated dilation (FMD) of the brachial artery, a measure of endothelial function, was assessed in 143 patients (99 men, 44 women), ages 40 to 84 years (mean age, 63 ± 10 years), with documented CHD.
RESULTS: Patients with significant depressive symptomatology, as indicated by a Beck Depression Inventory (BDI) score  10 (n = 47) showed attenuated FMD (p = 0.001) compared with patients that were not depressed (BDI <10; n = 96). The use of antidepressant medication was associated with improved FMD (p < 0.05).
CONCLUSIONS: The increased risk of cardiovascular events in CHD patients with elevated symptoms of depression may be mediated, in part, by endothelial dysfunction.
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Abbreviations and Acronyms
| | ANCOVA = analysis of covariance | | BDI = Beck Depression Inventory | | CHD = coronary heart disease | | FMD = flow-mediated dilation | | GTN = glyceryl trinitrate | | GTN-D = glyceryl trinitrate dilation | | LDL = low-density lipoprotein | | MI = myocardial infarction |
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