ORLANDO — Patients who were depressed after coronary artery bypass surgery were more likely to have atherosclerotic disease progression within their grafted vessels, in a post hoc analysis of data on 1,319 patients.
This finding should prompt a prospective study to assess whether depression plays a causal role in atherosclerosis, Dr. Ambar Kulshreshtha said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.
The new analysis used data collected in the Post Coronary Artery Bypass Graft trial, which was designed to test if an aggressive lipid-lowering regimen plus low-dose warfarin could slow progression of atherosclerosis within saphenous vein bypass grafts. The patients had undergone coronary bypass surgery 1–11 years prior to enrollment. The trial found that aggressive lowering of LDL cholesterol significantly reduced atherosclerosis progression within grafted veins, but low-dose warfarin had no benefit (N. Engl. J. Med. 1997;336:153–63).
Almost 98% of the patients were evaluated for depression at study entry using the Centers for Epidemiologic Studies depression (CES-D) scale. A CES-D score of 16–27 indicates mild depression and greater than 27 indicates moderate to severe depression. Of the postbypass patients, 127 scored 16 or greater. All patients also had a baseline coronary angiogram and follow-up examination an average of 4.2 years later.
After adjustment for baseline differences, patients depressed at entry had a 40% increased risk of having substantial atherosclerosis progression in their saphenous vein grafts, compared with patients who were not, which was significant, said Dr. Kulshreshtha, of Beth Israel Deaconess Medical Center, Boston.