Talking therapies that effectively treat depression in people over the age of 45 years were associated with reduced rates of cardiovascular disease, UK researchers reported.
Previous studies have demonstrated that depression could carry an extra lifetime risk of cardiovascular disease of up to 72% compared with people who did not experience depression. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the NHS via the Improving Access to Psychological Therapy (IAPT) primary care programme.
Research led by University College London (UCL) set out to determine whether successful therapy outcomes could be linked with cardiovascular risk reduction. To do so, they analysed data from electronic healthcare records of 636,955 people in England who had completed a course of psychotherapy between 2012 and 2020.
Depressive symptoms were measured before and after treatment using the Patient Health Questionnaire (PHQ-9), and the outcomes were linked to patients' healthcare records to check for new incidence of cardiovascular events.
An improvement in depression was defined as a reduction of 6 points or more in the PHQ-9 score and no worsening of anxiety between the start and end of treatment. Anxiety was included in the definition to ensure that the outcome of therapy was not considered good if depressive symptoms improved but anxiety worsened.
The study, published in the European Heart Journal, found that during a median follow up of 3.1 years, depressive symptoms improved in 59% of the participants and did not improve in 41%. During this period, there were 49,803 cardiovascular events and 14,125 participants died.
Reductions in Cardiovascular Disease Risk and Mortality
Reliable improvement from symptoms of depression was associated with an overall 12% lower risk of developing a new cardiovascular disease [hazard ratio 0.88, 95% CI: 0.86 to 0.89], and more specifically an 11% reduction in the risk of coronary artery disease, a 12% reduction in the risk of stroke, and a 19% reduction in all-cause mortality.
The association between positive psychotherapy outcomes and a lower risk of cardiovascular disease was stronger in those aged under 60 compared with the over 60s for all outcomes. Among the under-60s, there was a 15% decreased risk of cardiovascular disease and a 23% decreased risk of all-cause mortality. For those over 60 years, the reduction in risk was 5% and 15%, respectively.
Celine El Baou, the study's first author and a PhD candidate at UCL's department of psychology and language sciences said the findings "stress the importance of increasing access to psychological therapy to under-represented groups – for example, minority ethnic groups who may be more at risk of experiencing cardiovascular disease".
Commenting to the Science Media Centre, Professor Sir Nilesh Samani, medical director of the British Heart Foundation, said the study "provides further evidence that brain and heart health are connected, and that treating depression may have other significant benefits beyond improving mental health".
Tim Chico, professor of cardiovascular medicine at the University of Sheffield, commented: "It would be interesting to understand the effects of the talking treatment on whether people whose depression was treated were more likely to be physically active, eat a healthier diet, take prescribed medication, and the impact on blood pressure and cholesterol levels. Such effects might explain why treatment for depression could reduce risk of heart disease."
Robert Storey, professor of cardiology at the University of Sheffield, said: "Whilst clinical trials are required to understand more clearly what precise impact these therapies have on cardiovascular risk, the researchers' observations certainly resonate with those of clinicians in the field."