Coronary endothelial dysfunction associated with a depressive mood in patients with atypical angina but angiographically normal coronary artery

Background: Depression is a risk factor for the development of coronary heart disease but the relationship between coronary endothelial dysfunction and depression is not yet known. This study investigated whether depressive symptomatology is associated with coronary endothelial dysfunction in patients without coronary artery disease (CAD). Methods and results: Incremental acetylcholine (Ach; 20, 50 and 100 μg/min) and nitrate (200 μg/min) were infused into the left coronary ostium of 52 patients (male 30, 51.8 years) with depressive symptoms as indicated by a Beck Depression Inventory (BDI) score of ≥ 10 and a Hamilton Depression Rating Scale (HAM-D17) of ≥ 7 but without overt CAD or any vasoactive medications. Vascular responses to each drug were measured quantitatively at the mid-segments of the left anterior descending artery (LAD) and compared to those of 103 matched control subjects (male 64, 51.3 years) with angiographically normal looking LAD and as estimated by BDI < 10 and HAM-D17 < 7. Patients in the depressive group showed significant vasoconstriction compared with patients in the non-depressive group (p = 0.017, 0.090, 0.004 respectively). However, endothelium-independent vasodilatation to nitrates did not differ significantly between the two groups (p = 0.461). No differences in risk factors were found between the two groups. Conclusions: Depressive mood is associated with coronary endothelial dysfunction in patients without CAD, suggesting a possible mechanism by which depressive mood may act as a cardiovascular risk factor.