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Depression

Ein nach wie vor unterschätztes Risiko für die Entwicklung und Progression der koronaren Herzerkrankung

Depression

An underestimated risk for the development and progression of coronary heart disease

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Bedeutung der Depression als Risikofaktor bei der Entstehung und Progression der koronaren Herzerkrankung (KHK) und mögliche Pathomechanismen sind Gegenstand der vorliegenden Arbeit. Zur Abschätzung der Vorhersage kardiovaskulärer Ereignisse liegen vier Metaanalysen mit ≥100.000 eingeschlossenen Probanden aus Bevölkerungsstudien mit einem adjustierten relativen Risiko von 1.60–1.90 vor. Neben verhaltenswirksamen Effekten (Ernährung, Bewegung, Rauchen, mangelnde Medikamententreue) werden drei zentrale psychobiologische Pathomechanismen diskutiert. Hierzu zählt erstens eine Hyperregulation des autonomen Nervensystems mit erhöhter Herzfrequenzrate, überschießenden Herzfrequenzanstiegen und einer erniedrigten Herzfrequenzvariabilität. Zweitens: überschießende Stressantworten des endokrinen Systems (insbesondere der Hypophysen-Nebennieren-Achse (HPA-Achse) und drittens eine dauerhafte subklinische Erhöhung von Inflammationsparametern (Akute-Phase-Proteine; proinflammatorische Zytokine) mit Veränderungen des Gerinnungssystems (unter anderem durch Thrombozytenaktivierung). Eine anhaltende depressive Symptomatik erhöht auch das Risiko für die Entwicklung der endothelialen Dysfunktion, einer Vorstufe der Atherosklerose. Schließlich spielen gefährliche Nebenwirkungen von Antidepressiva eine Rolle.

Abstract

The aim of this article is to provide an overview on depression as a risk factor for the onset and follow-up of cardiovascular disease (CVD). In brief, the current state of psychobiological mechanisms bridging the gap between affective states and somatic consequences are presented. Four meta-analyses dealing with depression as a CVD risk factor in apparently healthy populations with >100,000 participants included, extracted an adjusted effect estimator of 1.60–1.90. Depressed subjects present with an unhealthier lifestyle (nutrition, smoking, physical activity). Three major psychobiological pathways directly acting on the circulatory system are under discussion: (1) hyperregulation of the autonomic nervous system (e.g., increased mean heart rate, increased heart rate responses, impaired heart rate variability), (2) overshooting stress responses of the endocrine system with impaired feedback mechanisms (e.g., for cortisol release), and (3) the immune system with dysregulated release of acute phase proteins and proinflammatory cytokines, all involved in a bidirectional crosstalk with the patient’s affective state and leading to platelet activation and flow mediated endothelial (dys-)function. Nonadherence and adverse side effects of medications also contribute to the lethal properties of depression in CVD.

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  1. Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland

    K.H. Ladwig, R.T. Emeny, S. Häfner & M.E. Lacruz

  2. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar und Deutsches Herz-Zentrum München, Technische Universität München, München, Deutschland

    K.H. Ladwig

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  1. K.H. Ladwig
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Ladwig, K., Emeny, R., Häfner, S. et al. Depression. Bundesgesundheitsbl. 54, 59–65 (2011). https://doi.org/10.1007/s00103-010-1195-8

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