Psychotherapy may lower CVD risk in patients with depression

Successful management of depression through psychological therapies may be associated with a reduced risk of cardiovascular disease (CVD), a study has shown.

CVD is the leading cause of death globally, accounting for 17.9 million deaths each year. “The risk of CVD is 72 percent higher in people with depression compared with healthy controls,” wrote the researchers. [Chronic Dis Transl Med 2022;8:296-304; World Psychiatry 2017;16:163-180]

Psychological therapies, including cognitive behavioural therapy (CBT) and interpersonal therapy, are delivered nationally in England via the Improving Access to Psychological Therapy (IAPT) primary care programme as first-line treatment of depression. To investigate whether reducing depression symptoms with psychological therapies is associated with a lower risk of incident CVD, the researchers identified 636,955 adult patients with major depressive disorder (MDD; mean age, 55 years; female, 66 percent) without CVD or dementia who attended IAPT services from the UK national electronic health record databases. [Eur Heart J 2023;doi:10.1093/eurheartj/ehad188]

After a median follow-up of 3.1 years, 59 percent of participants showed reliable improvement in depression symptoms (ie, reduction of ≥6 points in Patient Health Questionnaire-9 score and no deterioration of anxiety [ie, Generalized Anxiety Disorder Scale 7-item score of ≥4 points]), while 41 percent of participants showed no reliable improvement between the start and end of treatment. There were 49,803 cardiovascular events (7.8 percent) and 14,125 participants (2.2 percent) died.

Reliable improvement in depression symptoms was associated with significantly lower risks of new onset of any CVDs (hazard ratio [HR], 0.88; 95 percent confidence interval [CI], 0.86–0.89), coronary heart disease (CHD; HR, 0.89; 95 percent CI, 0.86–0.92), stroke (HR, 0.88; 95 percent CI, 0.83–0.94), and all-cause mortality (HR, 0.81; 95 percent CI, 0.78–0.84) vs no reliable improvement.

Notably, the association was stronger in patients aged <60 years than those ≥60 years (all CVDs: HR, 0.85 vs 0.94; p<0.001) (CHD: HR, 0.63 vs 0.94; p=0.009) (all-cause mortality: HR, 0.77 vs 0.85; p<0.001). “The findings are consistent with previous research suggesting that interventions to modify risk factors for CVD are more effective at a younger age,” said the researchers.

The mechanism underpinning the observed association was not evaluated by the researchers. “However, since lifestyle interventions have been found to be effective in reducing incident CVD, it is plausible that successful psychological treatment may facilitate lifestyle changes that are protective of CVD,” explained the researchers.

“Our findings suggest that successful outcomes of evidence-based psychological interventions may extend beyond psychological health and have long-term physical health benefits, particularly for those aged under 60 years,” noted the researchers. “Integrated care models for mental and physical health have been successful in people with long-term physical health conditions and extending those models for people at higher risk of CVD [eg, patients with depression] could be one way to increase access to services to underrepresented populations.”