Depression Increases Peripheral Artery Disease Risk

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SAN FRANCISCO — Depression increases the risk of peripheral artery disease (PAD), according to researchers who recommend that clinicians pay more attention to mental-health issues in patients with the disease.

The study from researchers at the San Francisco VA Medical Center and the University of California, San Francisco, was published online earlier this year by the Journal of the American Heart Association.1

The analysis of data from 1,024 participants in the Heart and Soul Study was led by Marlene Grenon, MD, CM, a vascular surgeon at SFVAMC and an assistant professor of surgery at UCSF. Heart and Soul is a prospective study of men and women with coronary artery disease who were followed for an average of seven years.

“We discovered that there was an association between depression and PAD at baseline and also found that the patients who were depressed at the beginning of the study had a higher likelihood of developing PAD during follow-up at seven years,” Grenon said.

“These findings add to the growing body of research showing the importance of depression in both the development and progression of PAD,” said senior author Beth Cohen, MD, MAS, a physician at SFVAMC and an assistant professor of medicine at UCSF. “This also emphasizes the need for medical providers to be attentive to the mental health of their patients who have developed or who are at risk for PAD.”

Modifiable risk factors such as smoking and reduced physical activity explained some of the PAD risk, according to the authors.

“We still don’t know which comes first,” said Grenon. “Is it that patients with PAD become depressed because their mobility is impaired or that people who are depressed engage in unhealthy behaviors such as smoking and lack of exercise and are thus more at risk of developing PAD? Or might it be a vicious cycle, where one leads to the other?”

Further research is needed to determine cause and effect, she said.

“As providers, we can help patients recognize the connections between mental and physical health,” added Cohen. “This may help reduce the stigma of mental-health diagnosis and encourage patients to seek treatment for problems such as depression.”

1. Grenon M, Hiramoto J, Smolderen K et al. “Association Between Depression and Peripheral Artery Disease: Insights From the Heart and Soul Study.” J Am Heart Assoc. July 25, 2012; 1: e002667 doi: 10.1161/?JAHA.112.002667
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