Heart disease, depression and stress can be a deadly combination, a new study finds.
Researchers looking at the effect of significant stress and deep depression on nearly 4,500 patients with heart disease called the pairing a "psychosocial perfect storm."
"The combination of high stress and high depression symptoms may be particularly harmful for adults with heart disease during an early vulnerability period," said lead researcher Carmela Alcantara, an associate research scientist at Columbia University Medical Center in New York City.
"We found that those who reported both high stress and high depression were 48 percent more likely than those with low stress and low depression to have another heart attack or die in the first 2.5 years of follow-up," she said.
Longer follow-up did not show a significant association, however.
People with both stress and depression were likely to report recent crying spells, and feeling they face overwhelming difficulties and can't handle personal problems.
Behavioral treatments, perhaps including therapy and exercise, might reduce their odds for death or heart attack in the near future, Alcantara said.
High stress alone, or depression alone, did not increase the risk of another heart attack or death, she said.
For the report, published March 10 online in the journal Circulation, Alcantara and colleagues collected data on 4,487 heart disease patients, aged 45 and older, enrolled in the Reasons for Geographic and Racial Differences in Stroke study.
Participants were interviewed in their homes and asked how often during the past week they felt depressed, lonely or sad, or had crying spells. They were also asked how often they felt unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way during the past month.
Over an average six years of follow-up, 1,337 participants died or had a heart attack, the researchers found. The risk was 48 percent higher for those with stress and serious depression than those not feeling emotionally drained, but only for the first 2.5 years.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, cautioned that this study only found an association, and did not prove that high levels of stress or depression caused heart attacks or deaths.
"Depression and stress have previously been found to be associated with the development of heart disease as well as fatal and nonfatal heart attacks and strokes in men and women already suffering from heart disease," he said.
This study, however, was not able to find a cause-and-effect relationship between heart disease, stress and depression, and an increased risk for heart attack or death, he said.