Lack of a Close Confidant Increases the Risk for Cardiac Events After a Heart Attack
Approximately one of every twenty Americans experiences ]]>depression]]> each year, and among those who have survived a ]]>heart attack]]> , that number takes a staggering leap. In fact, studies show that as many as 65% of patients who have had a heart attack experience symptoms of depression and 15% to 22% of those suffer from severe depression. This is significant because depression clearly increases the risk of death after a heart attack.
Studies have also shown that a lack of social support after a heat attack is associated with a patient’s poor compliance to a treatment plan and poor health outcomes. To address these issues, many hospitals now have programs specifically designed to identify depression and provide social support for their cardiac patients. But, what happens if these risks are present before a heart attack occurs? In a study published in the May 2004 issue of Heart , researchers considered how depression and lack of social support before a heart attack might influence how patients fair after a heart attack.
About the Study
The study included 583 adults who were admitted to a hospital with a diagnosed heart attack. Three to four days after the heart attack, patients were questioned on several different areas, including:
- Social support: defined in terms of a close confidant (someone the patient had regular contact with—at least once a month—and with whom he or she could share sensitive personal information and gain support)
- Anxiety and depression: assessed using the hospital anxiety and depression scale (HADS)
- Age, sex, marital status, and years of education
- Smoking and use of alcohol and illegal drugs
- Personal and family histories of cardiovascular disease, and personal psychiatric history
- Details of separation from parents during childhood
At the end of 12 months, nine study participants died from non-cardiac causes; these nine were excluded from the study analysis. Of the 574 study participants included in the final analysis, 118 experienced a definitive cardiac event; 29 of whom died from cardiac causes.
Although there was a high incidence of depression in the sample, the researchers found that the participants who experienced a cardiac event were not more likely to have depression before the heart attack. However, they were less likely to have a close confidant. In fact, the participants with a close confidant had only half the risk of a further cardiac event than those who did not. Additionally, those without a close confidant were more likely to have had two or more heart attacks when they first presented prior to recruitment into the study.
Other characteristics that increased a person’s risk of an additional cardiac event after a heart attack were female sex, a history of ]]>angina]]> (chest pain from low oxygen supply to the heart), use of prescription calcium channel blockers, and severity of the initial heart attack.
Although the study’s authors could not definitely say why having a consistent source of social support appeared to confer a protective effect, they did find that participants without such support were more likely to engage in behaviors that are associated with health risk, including:
- Drinking alcohol four or more times a week
- Consuming more than six drinks in a single session at least once a week
- Using illegal drugs
- Smoking tobacco
How Does This Affect You?
The study’s authors stress that, although they did not find a relationship between depression prior to a heart attack and health outcomes afterward, treating depression as a means to lower the risk of ]]>coronary artery disease]]> should not be ignored. If you are feeling depressed, talk with your doctor about your feelings and about what you can do to help overcome your depression.
Likewise, this study shows that the importance of social support should not be overlooked. Being socially connected has many health benefits. According to this and other studies, confiding in other people can be just as important as eating well and exercising when it comes to the health of your heart. If you are feeling alone or lack someone from whom you can gain support, explore what opportunities your community can provide for meeting people.
American Heart Association
National Institute of Mental Health
Bush DE, et al. Even minimal symptoms of depression increase risk after acute myocardial infarction. Am J Cardiol . 2001;5:337-341.
Depression and heart disease. National Institutes of Mental Health Web site. Available at: http://www.nimh.nih.gov/publicat/depheart.cfm . Accessed April 20, 2004.
Dickens, CM, et al. Lack of close confidant, but not depression, predicts further cardiac events after myocardial infarction. Heart. 2004;90:518-522.
DiMatteo MR, et al. Depression is a risk factor for noncompliance with medical treatment. Arch Intern Med . 2000;160:2101-2107.
Guck TP, et al. Assessment and treatment of depression following myocardial infarction. Am Fam Physician . 2001;64:641-648.
Last reviewed April 23, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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