The effectiveness of the treatment of stress and depression in coronary heart disease
The study of psychosocial factors as possible risk factors for coronary heart disease (RF KBS) is difficult due to the inaccuracy of definitions and units of measurement. Psychosocial factors such as depression, chronic hostility, social exclusion, and a feeling of lack of social support have always been associated with the risk of coronary heart disease.
However, it is necessary in further work to confirm this relationship and establish the effectiveness of interventions. With regard to the existence of a link between vascular risk and such psychosocial factors as work-related stress, type A behavior and anxiety, the data are heterogeneous.
Studies of therapeutic interventions, although not blind, noted the importance of improving psychosocial factors as part of preventive programs, especially with secondary prophylaxis.
The strongest evidence was obtained for patients after myocardial infarction (MI). Although many data show that stress and depression after MI are common and predictors of subsequent events, the results of interventions are limited. A meta-analysis of 37 small studies on the training of patients with coronary heart disease (CHD) in stress management showed that these efforts can reduce heart mortality by 34% and repeated myocardial infarction by 29%, possibly due to the favorable effect on blood pressure, cholesterol and MT. smoking, FA and eating habits.
In the randomized ENRICHD study, 2481 patients were included (26% – with a feeling of low social support, 39% – in clinical depression, and 34% – in both conditions) 4 weeks after MI. 50% of patients were randomized for cognitive behavioral therapy and drug therapy, if necessary, and the other 50% were in the conventional treatment group.
Intervention did not increase survival without events. It did have a positive effect on depression and a sense of social exclusion, however, the relative improvement in the intervention group compared with the conventional treatment group was less than expected, possibly due to the significant improvement in the condition of patients in the control group.
Preliminary evidence suggests that pharmacotherapy for depression after MI, revascularization, or diagnosis of CHD can improve morbidity and mortality. A randomized SADHART study (Sertraline Antidepressant Heart Attack Randomized Trial) showed the safety of sertraline (a selective serotonin reuptake inhibitor) in the treatment of recurrent depression in patients with cardiovascular diseases (CVD).
Sertralin did not affect LV EF, ventricular premature beats, or other cardiac indicators when compared with the placebo group. Depression and mood scales were better in the sertraline group, especially in depressed patients before heart attack, i.e. in a group in which the onset of depression after an attack is particularly likely. The frequency of repeated heart attacks, HF, episodes of chest pain and cardiac death was lower in the sertraline group than in the placebo group.
In the ENRICHD study, the use of antidepressants was also associated with significantly lower levels of nonfatal MI and deaths.