April 19, 2023

expert reaction to observational study of talking therapies for depression and future risk of cardiovascular disease

An observational study published in European Health Journal looks at psychological therapies for depression and cardiovascular risk.

Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, said:

“This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes. While observational, it provides further evidence that brain and heart health are connected, and that treating depression may have other significant benefits beyond improving mental health.

“However, more research is needed to demonstrate whether the therapy is actually causing the reduction in heart and circulatory conditions, and if so, how.”

Dr Camilla Nord, Group Leader, MRC Cognition and Brain Sciences Unit, University of Cambridge, said:

“This study provides robust support for an association between reduction in depression after psychological therapy and reduced future risk of cardiovascular disease. The sample is large and very comprehensive, including all the IAPT services in England. This study provides an important piece of the puzzle in understanding the well-established comorbidity between cardiovascular disease and depression, which could help reduce the risk of morbidity and mortality in mental health conditions. There are two notable limitations. At present, we do not know the causality of the association: other factors could have driven the finding, for example, psychological therapy might be less effective for depression in patients who already have a high risk of cardiovascular disease. We also do not know what could be driving this effect—for example, could a reduction in depression following therapy cause lifestyle changes (such as increased exercise) that reduce cardiovascular risk? If other types of research (such as randomised controlled trials) discover this relationship is causal, psychological therapies could one day be recommended for patients with depression to improve long-term physical health, not just mental health.”

Prof Robert Storey, Professor of Cardiology, University of Sheffield, said:

“This work provides an important clue that psychological or ‘talking’ therapies may reduce the long-term risk of heart attack or stroke. Through accessing a database of just under two-thirds of a million people in England who had received these therapies for depression and anxiety, the researchers found that those who responded well to therapy had a lower subsequent risk of heart disease or stroke. Whilst clinical trials are required to understand more clearly what precise impact these therapies have on cardiovascular risk, the researchers’ observations certainly resonate with those of clinicians in the field. We know that the risk of heart attack or stroke can be hugely influenced by lifestyle choices and persistence with taking medication for lowering cholesterol and blood pressure. People who have a greater sense of wellbeing tend to be better motivated to look after their cardiovascular health, such as by not smoking, taking more exercise, and, if needed, diligently taking cholesterol and blood pressure medication on a daily basis. This research should stimulate more attention on psychological therapies for improving long-term physical health.”

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“This study underlines the important link between depression and cardiovascular disease. Although this link is already known, patients with cardiovascular disease often are not formally assessed for depression, while the risk of heart disease in depressed people is also often overlooked.

“The study does not prove that treating depression using talking therapies reduces risk of later heart disease, though it suggests that it might. Although proving such a link would need a randomised clinical trial where depressed people are randomised to receive treatment or not, such a study is unlikely to be ethical.

“It would be interesting to understand the effects of the talking treatment on whether people whose depression was treated were more likely to be physically active, eat a healthier diet, take prescribed medication, and the impact on blood pressure and cholesterol levels. Such effects might explain why treatment for depression could reduce risk of heart disease.

“We need to consider how to improve detection and treatment of depression, not just because it is important in itself, but because it may also reduce the burden of heart disease to a similar extent as other treatments for heart disease.”

‘Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England’ by Céline El Baoua et al. was published in European Health Journal at 00:05 UK time on Wednesday 19^th April.

Declared interests

Dr Camilla Nord: “I have no interests to declare regarding this article.”

Prof Robert Storey: “No relevant DOIs for this statement.”

Prof Tim Chico: “No conflicts.”

For all other experts, no reply to our request for DOIs was received.