Psychological Interventions for Depression Associated with Reduced CVD Risk in New Study

Managing depression with psychological interventions may reduce cardiovascular (CV) risk, especially in patients aged <60 years, according to a study published in the European Heart Journal.

In a retrospective cohort study of 636 955 persons aged ≥45 years in England, researchers found that reliable improvement of depressive symptoms after psychological therapy was associated with a 12% decrease in cardiovascular disease (CVD) risk at any given time, with the association stronger in those aged <60 years.

“People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime,” wrote first author Céline El Baou, MSc, research assistant and PhD student at University College London, and colleagues. “It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction.”

Using linked national electronic health care record databases in England, and national hospital episode and mortality databases, El Baou and coauthors examined incidence of new-onset CVD, coronary heart disease (CHD), stroke, and all-cause mortality in 636 955 individuals who completed a course of psychotherapy after a median follow-up of 3.1 years. Among study participants, 65.6% were women and the mean age was 55 years.

The absolute risk for experiencing a CV event 4 years after psychological treatment was 7.64% in participants with reliable symptom improvement and 8.38% in those without improvement.

Results showed that risk for experiencing any CV event was reduced by 12% for persons who reliably improved after psychological therapy (hazard ratio [HR] 0.88, 95% CI 0.86-0.89) compared with those who did not. Also, after the median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of CHD (HR 0.89, 95% CI 0.86-0.92), stroke (HR 0.88, 95% CI 0.83-0.94), and all-cause mortality (HR 0.81, 95% CI 0.78-0.84).

Researchers observed that CVD risk reduction was 15% in participants aged <60 years (HR 0.85, 95% CI 0.82-0.87) compared with 6% in those aged >60 years (HR 0.94, 95% CI 0.91-0.97).

“These findings are important as they 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,” wrote El Baou and colleagues.

“Future research may focus on evaluating the causality of the association, by making observational work well aligned with criteria for approximating causality as well as increasing sample representativeness, including groups currently underrepresented in mental health services,” concluded investigators.

Reference: El Baou C, Desai R, Cooper C, et al. Psychological therapies for depression and cardiovascular risk: Evidence from national healthcare records in England. Eur Heart J. Published online April 18, 2023. doi:10.1093/eurheartj/ehad188.