Mecanismos fisiopatológicos da associação entre depressão e síndrome coronariana aguda
DOI:
https://doi.org/10.25118/2236-918X-5-4-2Palavras-chave:
Depressão, síndrome coronariana aguda, mecanismos fisiopatológicosResumo
A depressão tem sido associada à síndrome coronariana aguda (SCA), agravando o prognóstico durante e após a internação, independentemente dos fatores de risco tradicionais. Apesar de estudos diversos enfatizarem a alta prevalência e o grande impacto no prognóstico, a depressão é subdiagnosticada e subtratada na maioria dos pacientes com SCA. Um dos desafios no contexto científico tem sido elucidar os mecanismos subjacentes, especialmente os psicossociais e os fisiopatológicos. Neste trabalho, fazemos uma revisão bibliográfica sobre os possíveis mecanismos fisiopatológicos implicados na associação entre depressão e SCA. Dentre os mecanismos fisiopatológicos, destacam-se a aterogênese inflamatória, os fatores imunológicos, o aumento da atividade plaquetária, a variação da frequência cardíaca, as alterações hematológicas, os fatores neuroendócrinos, as alterações estruturais decorrentes de anormalidades vasculares, como a desordem vascular disseminada, as alterações fibrinolíticas, os fatores genéticos, as diferenças entre os gêneros, as alterações hormonais e o tratamento farmacológico. Apesar do reconhecido efeito fisiopatológico da associação entre depressão e SCA, existe uma escassez de publicações dedicadas a estudar os mecanismos relacionados. A realização de mais estudos pode, no futuro, dar embasamento à comunidade científica para que a investigação da depressão faça parte do protocolo de exame e tratamento dos pacientes com SCA.
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Abdallah MH, Arnacut S, Karrowni W, Dakiki HA. The management of acute myocardial infarcti on in developing countries. Int J Cardiol. 2006;111:189-94.
Liem SS, van der Hoeven BL, Oemrawsingh PV, Bax JJ, van der Bom JG, Bosch J, et al. Mission!: opti mizati on of acute and chronic care for pati ents with acute myocardial infarcti on. Am Heart J. 2007;153:14.e.1-11.
Portal Brasil. Doenças cardiovasculares causam quase 30% das mortes no País [Internet]. [cited 2015 Jun 26]. http://www.brasil.gov.br/saude/2011/09/doencas-cardiovascularescausam-quase-30-das-mortes-no-pais
Arzamendi D, Benito B, Tizon-Marcos H, Flores J, Tanguay JF, Ly H, et al. Increase in sudden death from coronary artery disease in young adults. Am Heart J. 2011;161:574-80.
Ahto M, Isoaho R, Puolljoki H, Vahlberg T, Kivelã SL. Stronger symptoms of depression predict high coronary heart disease mortality in older men and women. Int J Geriatr Psychiatry. 2007;22:757-63.
Vaccarino V, Parsons L, Peterson ED, Rogers WJ, Kiefe CI, Canto J. Sex differences in mortality after acute myocardial infarction: changes from 1994 to 2006. Arch Intern Med. 2009;169:1767-74.
Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task force for the redefinition of myocardial infarction. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50:2173-95.
Scirica BM. Acute coronary syndrome: emerging tools for diagnosis and risk assessment. J Am Coll Cardiol. 2010;55:1403-15.
Ford ES, Ajani UA, Croft JB, Critchley JA, Labartthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388-98.
Ruff CT, Braunwald E. The evolving epidemiology of acute coronary syndromes. Nat Rev Cardiol. 2011;8:140-7.
World Health Organization (WHO). Depression [Internet]. [cited 2015 Jun 26]. http://www.who.int/mental_health/management/depression/en/
Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, et al. Doenças crônicas não transmissíveis no Brasil: prioridade para enfrentamento e investigação. Rev Saude Publica. 2012;46(supl 1):126-34.
Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129:1350-69.
Lesperance F, Frasure-Smith N, Théroux P, Irwin M. The association between major depression and levels of soluble intercellular adhesion molecule 1, interleukin-6, and C-reactive protein in patients with recent acute coronary syndromes. Am J Psychiatry. 2004;161:271-7.
Frasure-Simth N, Lespérance F, Irwin MR, Salves C, Lespérance J, Théroux P. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry. 2007;62:302-8.
Rottenberg J. Cardiac vagal control in depression: a critical analysis. Biol Psychol. 2007;74:200-11.
Ziegelstein RC, Parakh K, Sakhuja A, Bhat U. Platelet function in patients with major depression. Intern Med J. 2009;39:38-43.
Steptoe A, Strike PC, Perkins-Porras L, Mcewan JR, Whirtehead DL. Acute depressed mood as a trigger of acute coronary syndromes. Biol Psychiatry. 2006;60:837-42.
Paz-Filho G, Licínio J, Wong M. Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma. Rev Bras Psiquiatr. 2010;32:181-91.
Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H, et al. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation. 1997;96:778-84.
Frazier L, Vaughn, W, Willerson J, Ballantyne CM, Borwinkle E. Inflammatory protein levels and depression screening after coronary stenting predict major adverse coronary events. Biol Res Nurs. 2009;11:163-73.
Alves TCTF, Fráguas R, Wajngarten M. Depressão e infarto agudo do miocárdio. Rev Psiquiatr Clin. 2009;36:88-92.
Lecchin F, van der Dijs B, Orozco B, Rodriguez S, Baez S. Elective stenting, platelet serotonin and thrombotic events. Platelets. 2004;15:462.
Bruce EC, Musselman DL. Depression, alterations in platelet function, and ischemic heart disease. Psychosom Med. 2005:67:S34-6.25. Nemeroff CB, Musselman DL. Are platelets the link between depression and ischemic heart disease? Am Heart J. 2000; 140:57-62.
Manica ALL, Leães CGS, Frey BN, Juruena MF. O papel da depressão na doença coronariana. Arq Bras Cardiol. 1999;73:237-43.
Parakh K, Sakhuja A, Bhat U, Ziegelstein RC. Platelet functi on in pati ents with depression. South Med J. 2008;101:612-7.
Carney RM, Steinmeyer B, Freedland KE, Blumenthal JA, Stein PK, Steinnhoff WA, et al. Nightti me heart rate and survival in depressed pati ents post acute myocardial infarcti on. Psychosom Med. 2008;70:757-63.
Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med. 2005;67:S29-33.
Carney RM, Blumenthal JA, Stein PK, Watkins L, Catellier D, Berkman LF, et al. Depression, heart rate variability, and acute myocardial infarcti on. Circulati on. 2001;104:2024-8.
Watkins LL, Grossman P. Associati on of depressive symptoms with reduced barorefl ex cardiac control in coronary artery disease. Am Heart J. 1999;137:453-7.
Porges SW. The polyvagal theory: phylogeneti c substrates of a social nervous system. Int J Psychophysiol. 2001;42:123-46.
Udupa K, Sathyaprabha TN, Thirthalli J, Kishore KR, Lavekar GS, Raju TR, et al. Alterati on of cardiac autonomic functi ons in pati ents with major depression: a study using heart rate variability measures. J Aff ect Disord. 2007;100:137-41.
Rott enberg J. Cardiac vagal control in depression: a criti cal analysis. Biol Psychol. 2007;74:200-11.
Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM. Impact of depression and anti depressant treatment on heart rate variability: a review and meta-analysis. Biol Psychiatry. 2010;67:1067-74.
Patt erson SM, Mathews KA, Allen MT, Owens JF. Stress-induced hemoconcentrati on of blood cells and lipids in healthy women during acute psychological stress. Health Psychol. 1995;14:319-24.
Wong ML, Dong C, Exposito K, Thakur S, LIiu W, Elashoff RM, et al. Elevated stresshemoconcentrati on in major depression is normalized by anti depressant treatment: secondary analysis from a randomized, doubleblind clinical trial and relevance to cardiovascular disease risk. PLoS One. 2008;3:2350.
Wassertheil-Smoller S, Shumaaker S, Ockene J, Talavera GA, Greenland P, Cochrane B, et al. Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Initi ati ve (WHI). Arch Intern Med. 2004;164:289-98.
Allen MT, Patt erson SM. Hemoconcentrati on and stress: a review of physiological mechanisms and relevance for cardiovascular disease risk. Biol Psychol. 1995;41:1-27.
Hou SJ, Yen FC, Tsai SJ. Is dysfuncti on of the ti ssue plasminogen acti vator (tPA)-plasmin pathway a link between major depression and cardiovascular disease? Med Hypotheses. 2009;72:166-8.
Yepes M, Lawrence DA. Tissue-type plasminogen acti vator and neuroserpin: a well-balanced act in the nervous system? Trends Cardiovasc Med. 2004;14:173-80.
Pietraszek MH, Takada Y, Nishimoto M, Ohara K, Ohara K, Takada A. Fibrinolyti c acti vity in depression and neurosis. Thromb Res. 1991;63:661-6.
Yamamoto K, Takeshita K, Shimokawa T, Yi H, Isobe K, Loskutoff DJ, et al. Plasminogen acti vator inhibitor-1 is a major stress-regulated gene: implicati ons for stress-induced thrombosis in aged individuals. Proc Natl Acad Sci U S A. 2002;99:890-5.
Pawlak R, Magarinos AM, Melchior J, McEwen B, Strikland S. Tissue plasminogen acti vator in the amygdala is criti cal for stress-induced anxiety-like behavior. Nat Neurosci. 2003;6:168-74.
Eskandari F, Mistry S, Marti nez PE, Torvik S, Koti la C, Sebring N, et al. Younger, premenopausal women with major depressive disorder have more abdominal fat and increased serum levels of prothromboti c factors: implicati ons for greater cardiovascular risk. Metabolism. 2005;54:918-24.
Lahhou-Laforet K, Alhenc-Gelas M, Pornin M, Bydlowski S, Seigneur E, Benetos A, et al. Relation of depressive mood to plasminogen activator inhibitor, tissue plasminogen activator, and fibrinogen levels in patients with versus without coronary heart disease. Am J Cardiol. 2006;97:1287-91.
Krishnan KR, Hays JC, Blazer DG. MRIdefined vascular depression. Am J Psychiatry. 1997;154:497-501.
Alexopoulos, GS. New concepts for prevention and treatment of late-life depression. Am J Psychiatry. 2001;158:835-8.
Iosifescu DV, Clementi-Craven N, Fraguas R, Papakostas GI, Peterson T, Alpert JE, et al. Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder. Psychosom Med. 2005;67:703-6.
Licínio J, Yildiz B, Wong ML. Depression and cardiovascular disease: co-occurrence or shared genetic substrates? Mol Psychiatry. 2002;7:1031-2.
McCaffery JM, Frasure-Smith N, Dubé MP, Théroux P, Rouleau GA, Duan QL, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med. 2006;68:187-200.
Ramasubbu R, Tobias R, Buchan AM, Bech-Hansen NT. Serotonin transporter gene promoter region polymorphism associated with poststroke major depression. J Neuropsychiatry Clin Neurosci. 2006;18:96-9.
Glassman AH, Maj M, Sartorius N. The association between depression and heart disease: the role of genetic factors. In: Glassman A, Maj MM, Sartorius N, editors. Depression and heart disease. Chichester: Wiley; 2010. p. 57-98.
Sookoian SC, Gonzalez C Pirola CJ. Meta-analysis on the G-308A tumor necrosis factor alpha gene variant and phenotypes associated with the metabolic syndrome. Obes Res. 2005;13:2122-31.
Merz CN, Kesley SF, Pepine CJ, Reichek N, Reis SE, Rogers WJ, et al. The Women s̀ Ischemia Syndrome Evaluation (WISE) study: protocol design methodology and feasibility report. J Am Coll of Cardiol. 1999;33:1453-61.
Solimene MC. Aspectos epidemiológicos da isquemia silenciosa em homens e mulheres. Rev Bras Cardiol. 2000;2:51-6.
Borzak S, Weaver WD. Sex and outcome after myocardial infarction: a case of sexual politics? Circulation. 2000;102:2458-9.
Conti RAS, Solimene MC, Luz PL, Benjó AM, Lemos Neto PA, Ramires JAF. Comparação entre homens e mulheres jovens com infarto agudo do miocárdio. Arq Bras Cardiol. 2002;79:510-25.
Berger JS1, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009;302:874-82.
Fava M. Diagnosis and definition of treatmentresistant depression. Biol Psychiatry. 2003;53:649-59.
Glassman AH, Roose SP, Bigger JT Jr. The safety of tricyclic antidepressants in cardiac patients. Riskbenefit reconsidered. JAMA. 1993;269:2673-5.
Glassman A. Depression and cardiovascular disease. Pharmacopsychiatry. 2008;41:221-5.
Stahl S. Psicofarmacologia – Base neurocientífica e aplicações práticas. 2ª ed. Rio de Janeiro: Medsi; 2002.
Ramasubbu R. Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases. Med Hypotheses. 2002;59:537-51.
Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilids KK, Patel U, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21:30-8.
Lespérance F, Frasure-Smith N. Sertraline for treatment of depression in acute coronary syndromes. JAMA. 2002;288:2403; author reply 2403-4.
Parissis JT, Fountoulaki K, Filippatos G, Adamopoulos S, Paraskevaidis I, Kremastinos46. Lahhou-Laforet K, Alhenc-Gelas M, Pornin M, Bydlowski S, Seigneur E, Benetos A, et al. Relation of depressive mood to plasminogen activator inhibitor, tissue plasminogen activator, and fibrinogen levels in patients with versus without coronary heart disease. Am J Cardiol. 2006;97:1287-91.
Krishnan KR, Hays JC, Blazer DG. MRIdefined vascular depression. Am J Psychiatry. 1997;154:497-501.
Alexopoulos, GS. New concepts for prevention and treatment of late-life depression. Am J Psychiatry. 2001;158:835-8.
Iosifescu DV, Clementi-Craven N, Fraguas R, Papakostas GI, Peterson T, Alpert JE, et al. Cardiovascular risk factors may moderate pharmacological treatment effects in major depressive disorder. Psychosom Med. 2005;67:703-6.
Licínio J, Yildiz B, Wong ML. Depression and cardiovascular disease: co-occurrence or shared genetic substrates? Mol Psychiatry. 2002;7:1031-2.
McCaffery JM, Frasure-Smith N, Dubé MP, Théroux P, Rouleau GA, Duan QL, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med. 2006;68:187-200.
Ramasubbu R, Tobias R, Buchan AM, Bech-Hansen NT. Serotonin transporter gene promoter region polymorphism associated with poststroke major depression. J Neuropsychiatry Clin Neurosci. 2006;18:96-9.
Glassman AH, Maj M, Sartorius N. The association between depression and heart disease: the role of genetic factors. In: Glassman A, Maj MM, Sartorius N, editors. Depression and heart disease. Chichester: Wiley; 2010. p. 57-98.
Sookoian SC, Gonzalez C Pirola CJ. Meta-analysis on the G-308A tumor necrosis factor alpha gene variant and phenotypes associated with the metabolic syndrome. Obes Res. 2005;13:2122-31.
Merz CN, Kesley SF, Pepine CJ, Reichek N, Reis SE, Rogers WJ, et al. The Women s̀ Ischemia Syndrome Evaluation (WISE) study: protocol design methodology and feasibility report. J Am Coll of Cardiol. 1999;33:1453-61.
Solimene MC. Aspectos epidemiológicos da isquemia silenciosa em homens e mulheres. Rev Bras Cardiol. 2000;2:51-6.
Borzak S, Weaver WD. Sex and outcome after myocardial infarction: a case of sexual politics? Circulation. 2000;102:2458-9.
Conti RAS, Solimene MC, Luz PL, Benjó AM, Lemos Neto PA, Ramires JAF. Comparação entre homens e mulheres jovens com infarto agudo do miocárdio. Arq Bras Cardiol. 2002;79:510-25.
Berger JS1, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009;302:874-82.
Fava M. Diagnosis and definition of treatmentresistant depression. Biol Psychiatry. 2003;53:649-59.
Glassman AH, Roose SP, Bigger JT Jr. The safety of tricyclic antidepressants in cardiac patients. Riskbenefit reconsidered. JAMA. 1993;269:2673-5.
Glassman A. Depression and cardiovascular disease. Pharmacopsychiatry. 2008;41:221-5.
Stahl S. Psicofarmacologia – Base neurocientífica e aplicações práticas. 2ª ed. Rio de Janeiro: Medsi; 2002.
Ramasubbu R. Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases. Med Hypotheses. 2002;59:537-51.
Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilids KK, Patel U, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21:30-8.
Lespérance F, Frasure-Smith N. Sertraline for treatment of depression in acute coronary syndromes. JAMA. 2002;288:2403; author reply 2403-4.
Parissis JT, Fountoulaki K, Filippatos G, Adamopoulos S, Paraskevaidis I, Kremastinosand coronary parameters on coronary pati ent rehospitalizati on]. Srp Arh Celok Lek. 2010;138:154-61.
Spieker L, Noll G. [Pathophysiologic cardiovascular changes in stress and depression]. Ther Umsch. 2003;60:667-72.
Strike PC, Steptoe A. Depression, stress and the heart. Heart. 2002;88:441-3.
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