Abstract
Background: Increased rates of depression are reported in coronary artery disease (CAD). In heart disease, depression increases disability, reduces quality of life, and increases mortality.
Hypothesis: The study was undertaken to examine the relationship between depression and thyroid axis function in patients with CAD.
Methods: In all, 73 patients with CAD, consecutively admitted to a cardiac rehabilitation hospital, were assessed for depression using the Hospital Anxiety and Depression scale (HADS). Blood was drawnfor assessment of thyroid axis hormones and the N‐amino terminal fragment of the pro‐B‐type natriuretic peptide (NT‐pro BNP).
Results: The patients with CAD with depressive symptoms had a higher prevalence of cardiac failure (p = 0.04), higher NT‐pro BNP concentrations (p = 0.02), and lower free tri‐iodothyronine (T3) concentrations (p = 0.04) than patients with CAD but without depressive symptoms. They also showed a strong trend (p = 0.058) toward a higher incidence of the low T3 syndrome. Higher NT‐pro BNP concentrations were related to lowertotal T3 concentrations (r = ‐0.294, p = 0.011) and to higher reverse T3 concentrations (r = 0.353, p = 0.002). In men, higher scores of depression were related to lower total T3 concentration (r = ‐0.289, p = 0.034) and to higher NT‐pro BNP concentration (r = 0.380, p = 0.005).
Conclusion: These findings suggest that symptoms of depression in patients with CAD are associated with changes in thyroid axis function and with cardiac impairment, especially in men.
Keywords: depression, coronary artery disease, low T3 syndrome, cardiac impairment, N‐amino terminal fragment of the pro‐B‐type natriuretic peptide, gender
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References
- 1. Rudisch B, Nemeroff CB: Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatry 2003; 54: 227–240 [DOI] [PubMed] [Google Scholar]
- 2. Ades PA, Savage PD, Tischler MD, Poehlman ET, Dee J, Niggel J: Determinants of disability in older coronary patients. Am Heart J 2002; 143: 151–156 [DOI] [PubMed] [Google Scholar]
- 3. Beck CA, Joseph L, Belisle P, Pilote L, and the QOLAMI Investigators (Quality Of Life in Acute Myocardial Infarction) : Predictors of quality of life 6 months and 1 year after acute myocardial infarction. Am Heart J 2001; 142: 271–279 [DOI] [PubMed] [Google Scholar]
- 4. Barth J, Schumacher M, Herrmann‐Lingen C: Depression as a risk factor for mortality in patients with coronary heart disease: A meta‐analysis. Psychosom Med 2004; 66: 802–813 [DOI] [PubMed] [Google Scholar]
- 5. Klein I, Ojamaa K: Thyroid hormone and the cardiovascular system. N Engl J Med 2001; 344: 501–509 [DOI] [PubMed] [Google Scholar]
- 6. Prange AJ Jr: Psychoendocrinology. A commentary. Psychiat Clin North Am 1998; 21: 491–505 [DOI] [PubMed] [Google Scholar]
- 7. Wartofsky L, Burman KD: Alterations in thyroid function in patients with systemic illness: The “euthyroid sick syndrome.” Endocr Rev 1982; 3: 164–217 [DOI] [PubMed] [Google Scholar]
- 8. Friberg L, Drvota V, Bjelak AH, Eggertsen G, Ahnve S: Association between increased levels of reverse triiodothyronine and mortality after acute myocardial infarction. Am J Med 2001; 111: 699–703 [DOI] [PubMed] [Google Scholar]
- 9. Klemperer JD: Thyroid hormone and cardiac surgery. Thyroid 2002; 12: 517–521 [DOI] [PubMed] [Google Scholar]
- 10. Hamilton MA, Stevenson LW, Luu M, Walden JA: Altered thyroid hormone metabolism in advanced heart failure. J Am Coll Cardiol 1990; 16: 91–95 [DOI] [PubMed] [Google Scholar]
- 11. Iervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M, L'Abbate A, Donato L: Low‐T3 syndrome: A strong prognostic predictor of death in patients with heart disease. Circulation 2003; 107: 708–713 [DOI] [PubMed] [Google Scholar]
- 12. Pingitore A, Landi P, Taddei MC, Ripoli A, L'Abbate A, Iervasi G: Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med 2005; 118: 132–136 [DOI] [PubMed] [Google Scholar]
- 13. Ascheim DD, Hryniewicz K: Thyroid hormone metabolism in patients with congestive heart failure: The low triiodothyronine state. Thyroid 2002; 12: 511–551 [DOI] [PubMed] [Google Scholar]
- 14. Emdin M, Passino C, Prontera C, Iervasi A, Ripoli A, Masini S, Zucchelli GC, Clerico A: Cardiac natriuretic hormones, neurohormones, thyroid hormones and cytokines in normal subjects and patients with heart failure. Clin Chem Lab Med 2004; 42: 627–636 [DOI] [PubMed] [Google Scholar]
- 15. Baughman K: B‐type natriuretic peptide—a window to the heart. N Engl J Med 2002; 347: 158–159 [DOI] [PubMed] [Google Scholar]
- 16. Haggerty JJ Jr, Stern RA, Mason GA, Beckwith J, Morey CE, Prange AJ Jr: Subclinical hypothyroidism: A modifiable risk factor for depression? Am J Psychiat 1993; 150: 508–510 [DOI] [PubMed] [Google Scholar]
- 17. Fava M, L'Abbate LA, Abraham ME, Rosenbaum JF: Hypothyroidism and hyperthyroidism in major depression revisited. J Clin Psychiat 1995; 56: 186–192 [PubMed] [Google Scholar]
- 18. Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiat Scand 1983; 67: 361–370 [DOI] [PubMed] [Google Scholar]
- 19. Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA: Anxiety and depression following myocardial infarction: Gender differences in a 5‐year prospective study. J Psychosom Res 2005; 58: 153–161 [DOI] [PubMed] [Google Scholar]
- 20. Jenkinson C, Layte R, Wright L, Coulter A: The U. K. SF‐36: An Analysis and Interpretation Manual: A Guide to Health Status Measurement with Particular Reference to the Short Form 36 Health Survey. Oxford, England: Health Services Research Unit, 1996. [Google Scholar]
- 21. Parissis JT, Adamopoulos S, Rigas A, Kostakis G, Karatzas D, Venetsanou K, Kremastinos DT: Comparison of circulating proinflammatory cytokines and soluble apoptosis mediators in patients with chronic heart failure with versus without symptoms of depression. Am J Cardiol 2004; 94: 1326–1328 [DOI] [PubMed] [Google Scholar]
- 22. Shanoudy H, Soliman A, Moe S, Hadian D, Veldhuis JD, Iranmanesh A, Russell DC: Early manifestations of “sick euthyroid” syndrome in patients with compensated chronic heart failure. J Card Fail 2001; 7: 146–152 [DOI] [PubMed] [Google Scholar]
- 23. Seminara SB, Daniels GH: Amiodarone and the thyroid. Endocr Pract 1998; 4: 48–57 [DOI] [PubMed] [Google Scholar]
- 24. Wiersinga WM: Propranolol and thyroid hormone metabolism. Thyroid 1991; 1: 273–277 [DOI] [PubMed] [Google Scholar]
- 25. Abbey SE, Stewart DE: Gender and psychosomatic aspects of ischemic heart disease. J Psychosom Res 2000; 49: 417–423 [DOI] [PubMed] [Google Scholar]
- 26. Stern MJ, Pascale L, Ackerman A: Life adjustment postmyocardial infarction: Determining predictive variables. Arch Intern Med 1977; 137: 1680–1685 [PubMed] [Google Scholar]
- 27. Vanderpump MPJ: The epidemiology of thyroid disease In Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text, ninth edition (Eds. Braverman LE, Utiger RD.). pp 398–406. Philadelphia: Lippincott Williams and Wilkins, 2005. [Google Scholar]
- 28. Frasure‐Smith N, Lespérance F, Talajic M: Depression following myocardial infarction. Impact on 6‐month survival. J Am Med Assoc 1993; 270: 1819–1825 [PubMed] [Google Scholar]