ElderWeb

Older people who suffer from depression are more likely to develop heart disease, according to recent research reported in the October 10 issue of Circulation Journal. Dr. Curt D. Furberg from Wake Forest University, Winston-Salem, North Carolina, and colleagues collected data on nearly 6,000 patients aged 65 years or older, including about 4,500 patients who had no cardiovascular disease at the start of the study, and found that people with the highest levels of depression had a 40% higher risk of coronary heart disease, and 60% higher risk of death than those who had the lowest depression scores. Every 5-unit increase in the average depression score was associated with a 15% increased risk of developing coronary heart disease and a 16% increase in death, after adjustment for other risk factors.

Depressive symptoms, like feelings of fear or loneliness, irritability, lack of concentration, and sleeplessness, occur in 19-30% of people age 65 years or older (about 5 million Americans), but only 1% of those affected receive treatment. Those with higher scores reported that they felt 'down,' didn't sleep well, were unhappy or had little hope about the future," notes Furberg. The researchers found that women reported more depressive symptoms than men. Married participants or those who lived with others had lower depression scores. Smokers and those who had problems performing daily activities due to physical impairment had higher scores. Participants who were inactive and overweight also had higher scores.

Furberg suggests several explanations for why depression might predispose some individuals to increased heart risk:

* Depression is associated with poor physical activity, less exercise, more smoking and an increase in other behaviors that increase heart disease risk.
* A depressed state increases mental stress, which may increase plaque formation and vessel blockages.
* Depression is thought to increase production of free radicals and fatty acids, which can damage the lining of blood vessels placing the person at higher risk for sudden death.

Because the study excluded people with prior heart attack or cardiovascular disease and those who were in a medical or retirement facility, Furberg says it is unlikely that the depressive symptoms occurred as a result of disease. It remains to be seen whether treating depression in the elderly will reduce the rate of heart disease and death. Two clinical studies involving the treatment of depression in elderly Americans are being undertaken.

A study in the latest issue of The Journal of the American Geriatrics Society found that poverty, lack of education and a lack of health insurance prevent many elderly black Americans from getting screened for cervical, breast and colon cancer. Dr. Verona Hegarty from the Veterans Affairs Medical Center in Durham, North Carolina, and colleagues conducted the research, and concluded that this lack of screening at least partly explains why blacks in the US are more likely to die of cancer than whites.

Previous studies have uncovered racial differences in cancer screening. To investigate why these differences occur, researchers interviewed more than 4,000 elderly Americans in 1986-1987 and followed up with nearly 3,000 people in 1992-1993. The follow-up survey included 1,246 blacks and 966 whites older than 70 years. Investigators asked patients about their use of the Pap smear; clinical breast examination and mammography; and rectal examination and fecal occult blood testing to diagnose colorectal cancer. Researchers concluded that black women were less likely than white women to be screened for cervical and breast cancer, and that elderly blacks were less likely to be screened for colon cancer.

Cardiovascular disease is the leading cause of death for older Americans, but physicians are often reluctant to perform coronary artery bypass surgery and other potentially life-saving operations on octogenarians, citing their age as an overwhelming risk factor. A new study published in the March issue of the Journal of the American College of Cardiology reveals that cardiac surgery can be a safe option for many elderly patients. Dr. Karen P. Alexander of Duke University Medical Center in Durham, NC examined data on 67,764 patients, 4,743 of them octogenarians, who underwent cardiac surgery at 22 centers participating in the National Cardiovascular Network (NCN). She found that octogenarians without other risk factors, such as a recent heart attack, did almost as well as their younger counterparts.