SOCIO-DEMOGRAPHIC INDICATORS IN PATIENTS WITH CORONARY HEART DISEASE ACCOMPANIED BY DEPRESSION

Abstract

Depressive disorders are more common both in the general population (more than 350 million people suffer from depressive disorders) and among patients with cardiovascular disease, especially coronary heart disease. The World Health Organization predicts that, by 2030, coronary heart disease and depressive disorders will play a leading role in disability and incapacity for work in the developed countries of the world. The prevalence of depressive disorders at the population level ranges from 2.5% to 10% [1, 2]. Depression is a risk factor for coronary heart disease, negatively influences the course of cardiovascular diseases, and adverse prognosis of the disease in such categories of people is a significant predictor [3, 4]. So, the Whitehall II study showed that the sharper the symptoms of depression, the higher the risk of coronary heart disease [5]. In addition, in patients suffering from cardiovascular diseases, the depressive state aggravates the clinical picture of the disease, and a direct link between the severity of depression and the risk of death has been established [6-11]. Because depression is not diagnosed and treated in time, patients often seek outpatient care and are hospitalized [11]. Due to complications of angina pectoris and many non-coronary complaints, patients' quality of life decreases. Thus, in patients with coronary heart disease in the postoperative period, against the background of depression, an additional decrease in their functional capabilities is revealed [12]. The negative influence of depressive disorders on the development of coronary heart disease is caused by behavioral and physiological mechanisms. The dysfunction of the hypothalamic-pituitary-adrenal, thyroid, and immune systems of the body and the disruption of serotonin, melatonin, and dopamine receptor activity are observed against the background of depression. One of the most important mechanisms of depression's effect on coronary heart disease prognosis is that sympathoadrenal system activation increases the risk of life-threatening cardiac rhythm disturbances [3, 5, 8, 13–15]. Depression significantly changes the behavior of patients with cardiovascular diseases and reduces their quality of life: patients do not want to follow their diet and treatment regimen, do not want to quit smoking or consuming alcohol, do not want to increase physical activity, and do not want to switch to a healthy lifestyle [16–19]. Often, depressive disorders are accompanied by anxiety. Anxiety increases the risk of coronary heart disease by about 41% and the risk of other cardiovascular diseases by up to 52% [20, 21], while increasing the risk of fatal cardiovascular cases [22] and reducing patients' social activity [23]. ]