Depression und koronare Herzerkrankung: pathogenetische Faktoren vor dem Hintergrund des Stresskonzeptes

Zusammenfassung

Kardiovaskuläre Erkrankungen sind immer noch mit Abstand die häufigsten Todesursachen in der westlichen Welt. Eine Vielzahl prospektiver Untersuchungen zeigt nun, dass initial herzgesunde Menschen ein höheres Risiko für kardiovaskuläre Ereignisse aufweisen, wenn bei Beobachtungsbeginn einzelne depressive Symptome oder ein depressives Syndrom vorlagen. Umgekehrt ist bei Patienten nach einem Myokardinfarkt ein depressives Syndrom mit einer schlechten kardialen Prognose vergesellschaftet. Die Kenntnis der pathophysiologischen Zusammenhänge zwischen affektiver und kardialer Erkrankung ist natürlich wesentlich, um eine bessere Prophylaxe kardialer Ereignisse bei depressiven Patienten zu gewährleisten. Während depressiver Episoden kommt es zu einer Aktivierung der Stress-Systeme, die wesentlich zu metabolischen und autonomen Risikovariablen beitragen können. Diese Übersicht fasst den aktuellen Stand der Kenntnisse in diesem Bereich zusammen.

Abstract

To date cardiovascular disorders still represent the most frequent cause of death in our western hemisphere. A number of prospective studies have now been able to show that patients with no prior history of heart disease run a higher risk of developing cardiovascular problems, if they either suffered a number of depressive symptoms or showed a depressive syndrome. Similarly, in patients who have suffered a myocardial infarction the presence of a depressive syndrome is frequently associated with poor clinical prognosis and outcome. Within this context the knowledge of the pathophysiological relationship between affective and cardiovascular disorders constitutes an essential element for instituting effective preventive measures for protecting depressed patients against the risk of suffering cardiovascular problems. The activation of stress-responsive systems during depressive episodes may contribute to metabolic risk factors and dysbalance of the autonomic heart regulation. The present overview provides a summary of current knowledge and findings within this area of research.

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