Additional risks for heart disease highlighted
21 March 2003
Some psychosocial factors are associated with a similar increased risk of coronary heart disease (CHD) to that associated with conventional risk factors, according to a new National Heart Foundation (NHF) position statement.
(Psychosocial factors are those related to the social and psychological aspects of a person's life.)
Depression, social isolation and lack of quality social support were significant risk factors for CHD, of a magnitude similar to smoking, dyslipidaemia (abnormal blood lipid levels, e.g. high blood cholesterol) and hypertension (high blood pressure), the NHF said (Medical Journal of Australia 2003; 178: 272-76).
The risk of CHD increases one- to 2-fold in people with minor depression, and 3- to 5-fold in people with major depression.
Similarly, people who were socially isolated had a 2- to 3-fold increased risk of CHD, and people who lacked quality social support, a 3- to 5-fold increased risk.
But there was no strong or consistent evidence of a causal link between CHD and other psychosocial risk factors, such as work-related 'stressors', hostility, anxiety disorders or type A behaviour.
(Type A behaviour is characterised by an overcommitted, rushed and competitive approach to work, which is believed to be associated with an increased risk of heart disease.)
The NHF has now recommended that depression, social isolation and lack of quality social support be taken into account during all CHD risk assessments and management.
'Given the association of depression in people with CHD is in the order of 30 per cent, sometimes higher, and that depression can influence the outcomes of people with coronary disease, it's very important that it is recognised and treated,' said Professor Andrew Tonkin, NHF director of health, medical and scientific affairs. 'But it doesn't mean we shouldn't continue to pay attention to the conventional risk factors.'
Clinical Associate Professor David Sullivan, head of the lipid clinic at Sydney's Royal Prince Alfred Hospital, agreed and warned that it was important not to be dragged into what he described as a 'my risk factor is more important than yours' situation.
'I think these psychosocial factors are worth exploring because that may lead to the introduction of new ... treatments,' he said.
'But I wonder, even though the researchers said they were independent risk factors, if there isn't a ... situation whereby the psychosocial factors are still influencing the lifestyle habits that determine the classical risk factors, such as smoking and increased lipid levels.'
Last Reviewed: 24 March 2003
- MOW 21/3/03
