Love keeps me alive

Study concludes that lack of a close confidante can produce adverse outcomes in MI patients

by Phillipa Rispin

Finally, evidence that love does mend a broken heart. Past studies have delved into the connection between heart disease and depression but the link between illness and social support has been somewhat neglected in the research realm � until now.

A report in the May issue of Heart has concluded that preexisting depression isn't linked to subsequent mortality or cardiac events. However, the presence or absence of a close confidant does affect patients' outcomes. Those who've experienced a myocardial infarction (MI) appear to fare better when they have emotional support from a friend or loved one, according to the British researchers.

Scientists at Manchester University and Manchester Royal Infirmary screened 1,034 patients three to four days after an MI. The researchers looked at demographic information (age, sex, marital status, years of education), smoking, use of alcohol and illegal drugs, and medical and psychiatric histories. They also asked participants about separation from parents during childhood. After 12 months of followup, investigators found that preexisting depression doesn't put you at greater post-MI risk, but social isolation does. Degree of intimacy, rather than number of social contacts, is important.

Lead author, Dr C M Dickens and his team commented that separation from parents might affect a child's ability to develop intimate relationships in adulthood and could increase the risk for ischemic heart disease. They also speculated that those without close confidants might delay seeking treatment or be less likely to stick to treatment after an MI. However, they stress, "this doesn't mean that physicians and cardiologists can ignore depression. The high prevalence of depression in our sample testifies to the importance of depression as a risk factor for developing an MI."

Wolfgang Linden, PhD, of the University of British Columbia's Behavioural Cardiology Laboratory, had some quibbles with the study's methodology. "This study isn't conclusive," he said. "For instance, investigators didn't objectively measure depression before an MI; they relied on subjective recall, when patients were still likely undergoing acute care and were very upset. It's also possible that patients were seeking explanations for this momentous event in their lives and thus overestimated negative emotions before the MI. If you're measuring the role of depression in cardiac rehabilitation, it's more important to assess a patient's mood a month or so after the event."

"Nonetheless, depression and lack of close confidants are two different features of the same over-all problem," Dr Linden said. "The study made a very useful finding. And although evidence is still patchy, there is growing support for the theory that difficulties in early life can cause barriers to emotional intimacy, which carries serious health ramifications."

His opinion was similar to that of Dr Brian Baker, a spokesman for the Heart and Stroke Foundation of Canada. "Over the last decade, many researchers have become aware of links between depression and outcomes after MI," Dr Baker commented. "This study shows an emerging and related finding: the importance of having a confidant. As compared to the importance of depression affecting outcome in ischemic heart disease, physicians generally don't appreciate these emerging findings about the quality of close relationships � including marriage � and the problem of social isolation in cardiac patients."