Depression and Progression of Heart Disease in Lupus

September 13, 2016

Study suggests that depression may lead to an increased risk of subclinical atherosclerosis in women with systemic lupus erythematosus.

It is known that patients with systemic lupus erythematosus (SLE) are predisposed to cardiovascular disease (CVD) and that they suffer early onset morbidity and mortality related to cardiovascular events. The fact that patients with SLE develop other traditional cardiovascular risk factors with greater frequency then the general population has been blamed for this increased incidence of CVD.  Such risk factors include:  high blood pressure, diabetes, and leading a sedentary lifestyle.

Though controversial, psychological stress and its relationship to inflammation may contribute to or exacerbate CVD.  Depression is common in patients with SLE and can be a vicious cycle whereby symptoms of SLE perpetuate depression and depression worsens the pain and quality of life of the sufferer. The authors of an article in the July 7 issue of Arthritis Care & Research, designed and carried out a prospective case-control study examining the relationship between depression and CVD.

The authors found that patients with SLE have increased risk over the general population for developing atherosclerosis and premature CVD. Atherosclerosis was quantified utilizing ultrasound to measure carotid intima-media thickening (CIMT), which was increased in women with SLE over control subjects. Further it was found that women with SLE and depression had increased progression of CIMT but not carotid plaque when compared to women with SLE who where not depressed. This finding is important because it was independent of other traditional cardiovascular risk factors commonly associated with CVD pointing to depression as an independent contributor to progression of atherosclerosis. Although subtle, this finding should not be overlooked. Depression is yet another modifiable factor that if identified and treated effectively may not just increase quality of life for women with SLE, but also slow the more rapid progression of CVD in these patients.

This is a novel association and worthy of further examination. Most risk factors for CVD involve lifestyle and compliance choices. Treating SLE as purely rheumatologic disease without addressing the mental state created or exacerbated by such a chronic and often debilitating condition may not only worsen quality of life but shorten it as well through progression of the leading cause of death in the western world, CVD. It is possible that depression causes women with SLE to eat more, exercise less or engage in activities like smoking or drinking alcohol, which contribute to CVD. It is also possible that depression in women with SLE may enhance the inflammatory response and directly accelerate its stimulation of cardiovascular deterioration. In any case, clinicians should recognize the importance of identifying and treating depression in women with SLE.

 

KEY POINTS:

- Women with SLE have an increased burden of premature atherosclerosis and CVD- related mortality, and the mechanisms for this increased risk are not fully understood. 


- Depression is a common comorbidity in women with SLE. 


- This study adds new information evaluating the potential association between depression and subclinical atherosclerosis in patients with SLE and identifies depression as a potential modifiable risk factor for CVD. 


 

 

References:

Jorge A, Lertratanakul A, Lee J, et al. "Depression and progression of subclinical cardiovascular disease in systemic lupus erythematosus," July 7, 2016. Arthritis Care & Research. DOI 10.1002/acr.22992