Serrano Carlos V, Setani Karina Tiemi, Sakamoto Erica, Andrei Anna Maria, Fraguas Renério
Heart Institute (InCor HCFMUSP), Avenida Enéas de Carvalho Aguiar, 44 Building II, 2nd Floor, Room 12, São Paulo, SP 05403-901, Brazil.
Vasc Health Risk Manag. 2011;7:159-64. doi: 10.2147/VHRM.S10783. Epub 2011 Mar 16.
Depression and coronary artery disease (CAD) are both extremely prevalent diseases. In addition, compromised quality of life and life expectancy are characteristics of both situations. There are several conditions that aggravate depression and facilitate the development of CAD, as well as provoke a worse prognosis in patients with already established CAD: inferior adherence to medical orientations (medications and life style modifications), greater platelet activation and aggregation, endothelial dysfunction, and impaired autonomic dysfunction (lowered heart rate variability). Recent literature has shown that depression alone is becoming an independent risk factor for cardiac events both in primary and secondary prevention. As the diagnosis of depression in patients with heart disease is difficult, due to similarities of symptoms, the health professional should perform a careful evaluation to differentiate the clinical signs of depression from those related with general heart diseases. After a myocardial infarction, depression is an independent risk factor for mortality. Successful therapy of depression has been shown to improve patients' quality of life and cardiovascular outcome. However, multicentric clinical trials are needed to support this inference. A practical liaison between qualified professionals is necessary for the better management of depressed patients with excess risk in developing CAD. Accordingly, pathophysiological and clinical implications between depression and CAD are discussed in this article.
抑郁症和冠状动脉疾病（CAD）都是极为常见的疾病。此外，生活质量下降和预期寿命缩短是这两种情况的共同特征。有几种情况会加重抑郁症并促进CAD的发展，以及在已患CAD的患者中引发更差的预后：对医疗指导（药物治疗和生活方式改变）的依从性较差、血小板活化和聚集增加、内皮功能障碍以及自主神经功能障碍受损（心率变异性降低）。最近的文献表明，仅抑郁症本身在一级和二级预防中都正成为心脏事件的独立危险因素。由于症状相似，心脏病患者的抑郁症诊断困难，因此医疗专业人员应进行仔细评估，以区分抑郁症的临床症状与一般心脏病相关的症状。心肌梗死后，抑郁症是死亡的独立危险因素。已证明成功治疗抑郁症可改善患者的生活质量和心血管结局。然而，需要多中心临床试验来支持这一推断。为了更好地管理有患CAD额外风险的抑郁症患者需要合格专业人员之间的实际联络。因此，本文将讨论抑郁症和CAD之间的病理生理及临床意义。
