The effect of major depression on endothelial functions in stable coronary artery disease

Objective: Although the relationship between depression and cardiac events were demonstrated in lots of studies, the mechanisms lying under this relationship are not clear yet. One of the possible mechanisms is endothelial dysfunction. Endothelial dysfunction reduces the synthesis of the protector substances against atherosclerosis associated with nitric oxide and prostaglandin and it causes to placement of leukocyte, lipid particles and macrophage on the intima tie of the blood vessel. The relationship between endothelial dysfunction and cardiovascular events was demonstrated in the earlier studies. Inşammation decreases the bioavailability across the endothelium by decreasing synthesis of NO and creation of endothelial NO synthase, which causes endothelial dysfunction. Depression has a relationship with the endothelial dysfunction, which is the possible result of the neurohormonal activation disruption. With considering its’ effect on the inşammatory process, depression is a significant factor for endothelial dysfunction. In this study, our aim is to study the effect of the major depression on the endothelial function on the patients, who have stable coronary artery disease (CAD).

Method: The patient group consists of 65 CAD patients who have major depression diagnosis according to DSM-IV-TR diagnosis measures and control group consists of 54 CAD patient who don’t have major depression diagnosis. To measure the degree of the disorder on the patients who have depression diagnosis, Montgomery-Asberg Depression Evaluation Measure (MADRS) was used. Endothelial functions had been evaluated with brachial artery şow mediated dilatation (FMD) which is a noninvasive method.

Results: The average age was found 59.9±10.4 for the patient group and 59.2±10.2 for the control group (p=0.715). The sociodemographic characteristics are found similar for patient and control groups. When the endothelial function variables of the patient and control groups considered, there was no significant difference in the basal velocity (p=0.242), basal diameter (p=0.908) and basal hyperemia velocity (p=0.533) values. Absolute value of FMD (p<0.001) and percentage of FMD value (p<0.001) was found significantly lower. No correlation was observed between MADRS score and endothelium function variables on the stable CAD patients, who have major depression diagnosis. Contrary to this there is meaningful correlation between MADRS score and FMD percentage value which is one of the endothelium function variables and absolute value of FMD on the stable KAH patients, who don’t have major depression diagnosis. Independent from age and sex, MADRS score was detected as the independent predictive of percentage value of FMD and absolute value of FMD in the linear regression analysis (β= -0.332, p<0.001).

Conclusion: In this study, we observed that endothelial dysfunction variables were significantly lower for the stable CAD patients who have depression diagnosis than stable CAD patients, who don’t have depression diagnosis and for these patients percentage value of FMD and absolute value of FMD are independent predictive of depression stress.