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Depression is frequently encountered in the context of many cardiovascular diseases. The epidemiology, pathophysiology, clinical presentation, and course of the depression vary in each of these medical conditions. They are therefore discussed separately in this chapter. However, the treatment of depression in the context of these various cardiovascular diseases differs very little and thus is covered in a single section at the end.



Coronary heart disease (CHD) results from narrowing of the arteries that supply blood to the heart, leading to acute myocardial infarction (MI), angina pectoris, and other ischemic heart disease. The American Heart Association estimates that 15 million Americans have CHD, a prevalence of 6.4% among adults aged 20 or older.1 Approximately 700,000 Americans have a new or recurrent MI each year.1 While rates of hospitalization and death due to MI decreased from 1999 to 2009, CHD was still the cause of one in six deaths in 2009.1 The 5-year mortality rate following a first MI is 36% for men and 47% for women aged 45 and older. Additionally, CHD is estimated to cost $195 billion per year in the United States in direct and indirect costs (Figs. 7-1 to 7-3).1

Figure 7-1

Top six causes of death in the Unites States, 2010. (Data from NHLBI fact book (2012) and Murphy SL, Jiaquan X, Kochanek KD. Deaths: Final Data for 2010, Natl Vital Stat Rep. 2013;61(4):1–117.)

Figure 7-2

Estimated total cost to the U.S. Economy, 2009. (Data from NHLBI fact book (2012) and Heidenreich PA, Trogdon JG, Khavjou OA, et al: Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association, Circulation. 2011;123(8):933–944.)

Figure 7-3

Mean risk of depression for selected illnesses (% prevalence for particular disease).

CHD is associated with elevated rates of depression. Prevalence of major depressive disorder (MDD) is approximately 17% to 27% among patients with CHD,2 compared to an estimated lifetime prevalence of 16% in the general population.3 An additional 20% to 30% of patients with CHD experience minor depression or subsyndromal depressive symptoms following MI.46 Patients undergoing coronary artery bypass graft surgery (CABG) due to CHD demonstrate rates of depression of about 20% to 25%, and rates as high as 38% are reported when minor depression is included.7,8 CHD is also associated with an increased risk of suicide, particularly within the first month of an MI, although the elevated risk may persist for several years.9

In addition to co-occurrence in individuals with already established CHD, depression ...

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