Depression and cardiovascular disease in women: Behavioral and biological mechanisms involved in this association

Cardiovascular disease (CVD) and depression are conditions that frequently co-occur, particularly among women. It has been estimated that about one in every five patients with CVD meets criteria for major depressive disorder, and an even greater number endorse subclinical levels of depressive symptoms. Most importantly, prospective studies have demonstrated that depression is a strong predictor of CVD onset, cardiac adverse events, and mortality from CVD. This association appears to be more pronounced among women. As evidence accumulates, great interest has been given to putative mechanisms that may account for this association and both behavioral and biological pathways have been proposed. The leading behavioral hypotheses suggest depression is likely to increase the risk of CVD through its influence on medication adherence and/or poor health behaviors. Biological pathways posited to link these two conditions include the inflammatory response, hypothalamic-pituitary-adrenal axis activity, genetic influences, and the adipokine, leptin. Although further research is needed to better integrate the behavioral and biological pathways linking these two conditions, intervention efforts are already on their way. Various randomized clinical control trials targeting depressive symptoms among men and women with CVD have been conducted, increasing our knowledge on how to safely address depression in the context of CVD.