Taking hopelessness to heart.

Nagging despair and emotional distress markedly boost a person's chances of developing heart disease and dying from its consequences, according to a new study,

Hopelessness and sadness that linger for years, yet fall short of "severe depression," can undermine heart function, the researchers assert. At mild to moderate levels, depression - like high blood pressure - may wreak cardiovascular havoc if left uncontrolled, they hold.

Led by Robert Anda of the Centers for Disease Control and Prevention in Atlanta, the investigators studied 2,832 adults ranging in age from 45 to 77. The participants, who were tracked for an average of about 12 years, entered the study free of heart disease and other chronic illnesses. Initial examinations included questions about feelings of depression, discouragement, and hopelessness experienced in the previous month. Research has shown that responses to these questions remain consistent over time.

About 11 percent of the volunteers noted symptoms of at least mild depression. In addition, 11 percent cited moderate hopelessness and 3 percent reported severe hopelessness.

All three of these groups suffered a significantly greater death rate from heart disease over the follow-up period compared with those reporting no depression or hopelessness. The researchers statistically controlled for sex, age, cigarette and alcohol use, blood pressure, and other factors linked to heart ailments. Deaths from heart disease were four times more prevalent among participants who reported severe hopelessness than among those who reported no hopelessness. Cases of nonfatal heart disease also emerged more often in depressed adults. Among depressed and hopeless people, cigarette smoking boosted even further the risk of contracting and dying from heart disease, the researchers note in the July EPIDEMIOLOGY. Other scientists have found that a potentially fatal blood-vessel disease progressed more rapidly in mildly to moderately depressed men who smoked cigarettes than in nondepressed smokers (SN: 3/28/92, p. 196).

The physiological effects of prolonged depression and hopelessness may contribute to heart disease by promoting blood clots and thickening of artery walls, Anda speculates.