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Depression: Risikofaktor für kardiovaskuläre Erkrankungen

Depression: risk factor for cardiovascular disease

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Zusammenfassung

Die Depression ist ein unabhängiger Risikofaktor für die Entstehung und einen ungünstigen Verlauf einer kardiovaskulären Erkrankung. Dabei spielen depressionsassoziierte Veränderungen biologischer Parameter sowie Verhaltensvariablen eine wichtige Rolle. Diese Faktoren werden als mögliche Mechanismen in diesem Beitrag näher erläutert. Zu den möglichen biologischen Faktoren gehören Veränderungen des autonomen Nervensystems, der Hypothalamus-Hypophysen-Nebennierenrinden-Achse, des Immunsystems sowie des Gerinnungssystems. Zusätzlich steigt durch eine Depression das Risiko für weitere Erkrankungen, wie Diabetes oder Adipositas, die selbst ein erhöhtes kardiovaskuläres Risiko beinhalten. Auf der Verhaltensebene finden sich oft Veränderungen hin zu einem ungesunden Lebensstil, z. B. durch vermehrtes Rauchen und körperliche Inaktivität. Eine Depression erschwert außerdem erforderliche Verhaltensänderungen und eine Medikamentenadhärenz. Bei der antidepressiven Medikation wiederum muss das kardiovaskuläre Risikoprofil verschiedener Substanzen bedacht werden. Alle diese Faktoren spielen eine wichtige Rolle im Zusammenhang zwischen Depression und kardiovaskulären Erkrankungen.

Summary

Major depression is an independent risk factor for the development of cardiovascular disease. In patients with existing cardiovascular disease, major depression has a large impact on the quality of life and is associated with a poor course and prognosis. Potential mechanisms responsible for this association can be categorized as biological and behavioural variables that do not exclude each other but interact. Biological factors include alterations of the autonomous nervous system, the hypothalamic-pituitary-adrenal axis, the immune system and the vascular system. Major depression also raises the risk for further diseases, such as diabetes mellitus or obesity, which themselves are associated with higher cardiovascular risks. On a behavioural level, depression is often associated with an unhealthy life style such as smoking and physical inactivity. Additionally, depressed patients have more difficulties to implement recommended behavioural changes and to adhere to medication. Furthermore, some classes of antidepressants may also increase cardiovascular risk. All these factors play an important role in the association between depression and cardiovascular disease.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Christian Otte: Forschungsförderung – Deutsche Forschungsgemeinschaft (Exzellenzcluster NeuroCure, OT 209/7-1), Stiftung Deutsche Depressionshilfe, National Alliance for Research in Schizophrenia and Depression (NARSAD); Beratungstätigkeit – Phineo; Vortragshonorare – Astra Zeneca, Berlin Chemie, Lundbeck, Servier.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    L.K. Kuehl & C. Otte

  2. Department of Psychiatry, VU University Medical Centre, Amsterdam, Niederlande

    B.W.J.H. Penninx

Authors
  1. L.K. Kuehl
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  2. B.W.J.H. Penninx
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  3. C. Otte
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Correspondence to L.K. Kuehl.

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Kuehl, L., Penninx, B. & Otte, C. Depression: Risikofaktor für kardiovaskuläre Erkrankungen. Nervenarzt 83, 1379–1384 (2012). https://doi.org/10.1007/s00115-012-3584-8

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