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First Published Friday, 16 January 2009

Published: December 15, 2008

People who are depressed are literally sick at heart: they have a significantly increased risk for cardiovascular disease, and no one knows exactly why. Now three new studies have tried to explain this, and they arrive at subtly different conclusions.


The first, led by Dr. Mary A. Whooley of the Veterans Affairs Medical Center in San Francisco, studied 1,017 patients with coronary artery disease for an average of more than four years. Although the study found an association of depression with heart disease, when researchers statistically corrected for other medical conditions, disease severity and physical inactivity, the association disappeared.


They concluded with a relatively straightforward explanation: depression leads to physical inactivity, and lack of exercise increases the risk for heart disease. The study appears in the Nov. 26 issue of The Journal of the American Medical Association.


A second study, published Tuesday in The Journal of the American College of Cardiology, provides a different perspective. It included more than 6,500 healthy men and women with an average age of 51. Researchers tested them for depressive symptoms and followed them for an average of more than seven years.


This study, too, found that behavioral issues like smoking and inactivity were the strongest factors in the increased risk for heart disease among people who are depressed or anxious, accounting for 65 percent of the difference in risk. But they also found that depressed people had higher rates of hypertension and higher levels of C-reactive protein, and that these two physiological factors together accounted for about 19 percent of the increased risk. Mark Hamer, a senior researcher at University College London, was the lead author.


While these two studies suggest that the mechanism by which depression exerts its effect is mostly or entirely through poor health behaviors, a third study, in the December issue of The Archives of General Psychiatry, found that something else might be even more important.


This paper, whose senior author was Dr. Brenda Penninx, a professor of psychiatry at VU University in Amsterdam, studied 2,088 well-functioning adults ages 70 to 79. It found no difference in physical activity between those who were depressed and those who were not.


But it did find that depressive symptoms were associated with an increase in visceral fat accumulation — the pot belly that is a known risk factor for cardiovascular illness. This suggests that there is a biological mechanism that links depression with physiological changes independent of how much a person exercises.


To further complicate matters, Dr. Penninx suggested that her physically healthy subjects might have a different kind of depression. “There is now quite a lot of evidence that among heart attack patients, the physical symptoms of depression are more prevalent,” she said, “which suggests that their depression is different from that seen in an otherwise healthy sample.”


For now, Dr. Hamer, of London, offered what might be the last word on the complicated relationship between depression and heart disease.


“It’s really quite difficult to understand,” he said.


Source:   http://www.nytimes.com/2008/12/16/health/research/16depr.html?ref=research


Dial for suspected stroke

Hypertension and Stroke Health Alert


Call 911 — Not a Healthline — for Suspected Stroke


Much more publicity is given to the symptoms of a heart attack than a stroke. Yet like a heart attack, a stroke is an emergency that requires immediate medical attention. It’s essential to get to the hospital as soon as symptoms start, since drug therapy is most likely to be effective within the first three hours of stroke onset.


People who call a hospital’s medical-advice healthline instead of 911 for a suspected stroke can lose critical time due to delays or misinformation, according to a study published in the journal Stroke (Volume 38, page 2376) .


The researchers called 46 U.S. hospital healthlines and presented operators with a typical scenario of stroke symptoms. The operators were then asked which of four responses they would give: wait and see if symptoms subside; call your primary care doctor; drive to your local urgent-care center; or call 911 for an ambulance. While 78% of the healthline operators gave the correct response — call 911 — 22% recommended that the caller contact his or her primary care doctor, including 32% of the operators who worked for healthlines at certified stroke centers. Moreover, 39% of the healthline calls were transferred at least once (usually to the emergency department), and one quarter of the operators couldn’t identify even one sign or symptom of a stroke.


A stroke is a medical emergency and time is of the essence, so if you suspect that you or someone else is having a stroke, immediately call 911, not a medical-advice healthline. Emergency-room doctors are the ones who should make the decision whether symptoms are of a stroke or not.


Listed below are the symptoms of a stroke, as well as what to do in the event of a stroke.


Symptoms of Stroke:


  • *Sudden weakness or numbness in the face, arm, or leg on one side of the body.
  • *Sudden loss, blurring, or dimness of vision.
  • *Mental confusion, loss of memory, or sudden loss of consciousness.
  • *Slurred speech, loss of speech, or problems understanding others.
  • *Sudden, severe headache with no apparent cause.
  • *Unexplained dizziness, drowsiness, loss of coordination, or falls.
  • *Nausea and vomiting, especially when accompanied by any of the above symptoms.

Actions To Take in the Event of a Stroke:


  • *Stay calm. Ignore any tendency to downplay a stroke symptom; it’s common for people to deny the possibility of something as serious as a stroke. Don’t hesitate to take prompt action.
  • *Call or have someone call an ambulance. (Dial 911 in most parts of the United States.) Be sure to give your name, telephone number, and exact whereabouts.
  • *While waiting for the ambulance, the person suffering the stroke should be made as comfortable as possible and should not eat or drink anything other than water.
  • *If an ambulance cannot arrive for an extended period of time, a family member or neighbor should drive the stroke patient to the hospital. Under no circumstances should the person experiencing the stroke symptoms attempt to drive.
  • *Notify the stroke patient’s doctor. He or she can provide the hospital with the patient’s medical history, which may be important for determining the best type of treatment for the stroke.



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