Talking therapies could reduce future risk of cardiovascular disease

Using talking therapies to effectively treat depression in adults over the age of 45 may be linked with reduced rates of future cardiovascular disease, finds a new analysis of health data led by UCL researchers.

In the first-of-its-kind study, published in the European Health Journal, researchers assessed whether evidence-based psychological therapies, such as cognitive behavioural therapy (CBT), used to treat depression could play a role in reducing the risk of cardiovascular disease later in life.

Cardiovascular diseases, such as stroke and heart disease, are the leading cause of death worldwide. They represent 32% of all deaths, with 18.6 million people having died from this cause in 2019 globally. Previous studies have also shown that people who experience depression are approximately 72% more likely to develop cardiovascular disease in their lifetime, compared to people who do not.

The new research analyses data from 636,955 people over the age of 45 who accessed treatment via England’s national Improving Access to Psychological Therapies (IAPT) service, between 2012 and 2020 (soon to be called “NHS Talking Therapies for anxiety and depression”).

IAPT is a free service and offers CBT, counselling and guided self-help, with sessions delivered either face-to-face individually or in groups online.

Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), which considers factors such as a lack of interest in doing things, issues with sleep and feelings of low mood.

Researchers then linked the IAPT outcomes (depression scores) with patients’ healthcare records to look for new incidence of cardiovascular events.

The team found that people whose depression symptoms reliably improved after psychological treatment were less likely to develop cardiovascular disease over an average of three years of follow-up, compared to those who did not.

Reliable improvement from depression (compared to no reliable improvement) was associated with a 12% decrease in future cardiovascular disease at any given time, with similar results observed for coronary heart disease, stroke and death.

The association was stronger in people below 60 years old, who had a 15% decreased risk of cardiovascular disease and 22% decreased risk of death from all causes respectively.

Meanwhile, those over the age of 60 had a 5% decreased risk of developing cardiovascular disease and 14% decreased risk of death from all other causes.

Lead author, PhD candidate Celine El Baou (UCL Psychology & Language Sciences) said: “This study is the first to establish a link between psychological therapy outcomes and future risk of cardiovascular disease.

“The findings are important as they suggest that the benefits of psychological therapy may extend beyond mental health outcomes and have long-term physical health. They stress the importance of increasing access to psychological therapy to under-represented groups, for example minority ethnic groups who may be more at risk of experiencing cardiovascular disease.”

The dataset used in this study was funded by Alzheimer’s Society.

Study limitations

Further research is needed to establish whether this link between improvement over therapy and cardiovascular disease is indeed causal, and what mechanisms would be involved. For example, the researchers had little information about lifestyle behaviours, such as exercise or smoking habits.

Another explanation for the results could be that those who respond to psychological therapy had lifestyle behaviours that were more protective of cardiovascular disease in the first place.

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