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New research suggests that depression does not cause heart attacks or related problems in patients with heart disease.

Multiple studies have described strong associations between depression and heart problems in people with heart disease. However, lead author Dr. Ralph A. H. Stewart, at the University of Auckland, New Zealand, and colleagues suggest in their paper, published in a recent issue of the European Heart Journal, that many of these studies only looked at the period soon after a heart attack or other cardiac event.

Theorizing that depression is merely a marker for increased risk attributable to other factors, Stewart's group assessed depressive symptoms in 1130 individuals several months after the cardiac event occurred.

At the start of the study, 22 percent of subjects had depressive symptoms. During a follow-up period of around eight years, there were 114 cardiac-related deaths, 108 nonfatal heart attacks, 53 nonfatal strokes, and 274 cases of severe chest pain.

After accounting for the subject's age, sex, and geographic location, the authors observed no association between depressive symptoms and cardiac deaths. There was a modest association with nonfatal heart events, the report indicates, and a strong association between depressive symptoms and certain heart symptoms.

After factoring in the effects of heart disease risk factors, socioeconomic variables and symptoms of heart disease, there was no evidence of an association between depressive symptoms and prognosis, they report.

But even if depression doesn't directly cause heart problems, depression in medically ill patients should not be ignored, Dr. Jurgen Unutzer, a psychiatrist at the University of Washington in Seattle, told Reuters Health.

In reviewing the report, Unutzer noted that the team used a brief screening test to assess depressive symptoms at one point in time. "It would be helpful to see if the patients met the clinical diagnostic criteria for depression."

Unutzer agrees with the researchers' assertion that large randomized clinical trials are needed to further explore the link between depression and heart problems.

Regardless, treatment for depression is important in and of itself, because depression causes "tremendous decreases in quality of life and functional impairment in any group of patients with chronic illness," he said. "Treating depression makes a huge difference in quality of life and function."

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