Prognostic implications of depression in ischemic syndromes

In a nation of almost 300 million people, ischemic heart disease (IHD) and depression remain two of the nation's most pressing public health issues. Cardiovascular disease remains the leading cause of death and hospitalization in the USA, and according to the American Heart Association, IHD alone demonstrated a total prevalence of 13 million individuals (6.9% of the US population) and was responsible for 2,125,000 hospital discharges, 656,000 deaths, and $142 billion in health care spending in 2002 [1]. As a growing proportion of patients survive myocardial infarction (MI), the number of patients with chronic, often nonrevascularizable IHD continues to increase. According to the National Institute of Mental Health (NIMH), 5% of the American population suffers from major depressive disorder (MDD) in any given 1-year period [2], and depression has been identified by the World Health Organization (WHO) as the leading cause of disability worldwide [3].