Categories · Health

Novel Risk Factors for CVD

Depression, night shift may increase cardiovascular risk

Depression is an independent risk factor for cardiovascular disease.

This was stressed  by Dr. Nasser Ghaemi, a professor at the Department of Psychiatry, Tufts University School of Medicine during the recent 2nd Experts’ Convergence for Health Outcomes (ECHO) Summit in Manila.

When one is depressed, this impacts the entire body and can increase one’s risk of developing the risk factors that lead to CVD, explained Dr. Ghaemi.

What is depression?

The World Health Organization (WHO) defines depression as “a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.”

According to WHO, at least 350 million people live with depression and it is the leading cause of disability worldwide. Apparently, depression remains hidden – not treated or talked about.

Although health experts now agree that depression is a risk factor for CVD, the question is whether treating it would improve cardiovascular outcomes. “Data shows clinical benefits, but may suggest biological benefits so it’s hard to know how to interpret it,” says Dr. Ghaemi.

By far, the lowest depression prevalence rates are in Asia and the highest rates are in Europe. In the United States, Canada, and Europe, around 10 percent of the general population meet the official definition of having at some point in their lives a major depressive episode. In Asia and Middle East, the prevalence is about 1 percent.

However, Dr. Ghaemi clarifies that the criteria for depression that were developed in the West for Caucasian populations don’t capture the experience of depression in Asian population.

In China, the experience of depression is much more physical than psychological. They don’t say: “I’m sad/unmotivated/uninterested in things” which is what the Western definition is. Instead they would say: “I have a headache/I’m tired/My stomach or heart hurts/I have diarrhea.”

“That’s physical expression of depression. So when you ask a question, ‘Is there depression?’ You have to translate what depression means in Asia compared to other parts of the world,” says Dr. Ghaemi.

Depression as a symptom

Like fever, depression is a symptom and a sign of other diseases/problems, and not a disease by itself.

“When the symptoms are there for two weeks and they’re severe, we call them major depressive episodes. But sometimes, very frequently, the symptoms aren’t there for two weeks at a severe level, then maybe moderate or depressive symptoms, mild depressive symptoms,” says Dr. Ghaemi.

However, depression in heart disease doesn’t have to have severe symptoms for it to be a risk for heart disease. Even mild and moderate symptoms are enough.

According to Dr. Ghaemi, the studies usually identify severe depression and they say it’s 1 percent in Asia. But the symptoms are going to be much higher than that. In the West for instance, 10 percent of the population have severe depression, probably 20-30 percent will have mild/moderate symptoms.

Shift workers

Apart from depression, shift working is also known to be a risk factor to many diseases such as psychiatric and CVDs as it jams the whole physiology of the body.

“God made us to sleep at night. Melatonin and other hormones are functioning differently at different hours of the day, the steroids have their own day and night curb,” explains Dr. Amos Pines, the co-founder of the Israel Menopause Society and is currently Associate Professor at the Sackler Faculty of Medicine in Tel-Aviv University. He was also one of the invited faculty for the ECHO Summit.

Dr. Pines warned call center agents, physician in-training or healthcare professionals, and other people working at night not to use it as an excuse to eat and smoke more.

“There’s probably nothing you can do worse for your health than smoking and then by doing that working at night, shifting, and feel sorry perhaps, eat more. It gets to a judicious cycle. It’s not good for you,” says Dr. Pines.

But it’s not only working at night that has an impact, “if you’re not sleeping at night, you don’t get your normal sleep pattern, which is very essential to restoring many hormonal and bodily functions during the sleep then you suffer,” Dr. Pines warns.

There are hormonal changes that occur normally at sleep than awake. These hormonal changes can shift if one’s awake mostly at night and sleep during the day.

Evidence shows that shift work is bad, but what’s worst is changing of shifts on a weekly basis. “People who work continuously at work and sleep in the day have a higher risk than people who have normal sleeping patterns. When they’re off work and they stay awake at day time and sleep at night, the normal way that would be probably worse than continuously working at night,” Dr. Pines concludes.

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