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DURHAM, N.C. -- Having both depression and type 2 diabetes
increases the risk of death for heart patients. Each factor had
been known to increase the risk of heart disease deaths by
itself, but together they're even more deadly.

In an analysis of more than 900 patients with established
coronary artery disease, Duke University Medical Center
psychologists found that those with both type 2 diabetes and
symptoms of depression were more likely to die than heart
patients without those conditions.

The study showed that among type 2 diabetes patients, having
high depression scores increased the risk of dying by 20 to 30
percent compared to patients with similar depression scores but
no type 2 diabetes.

"We found a trend showing that the probability of death
increases as the level of depression increases in diabetic
patients with coronary artery disease," said Duke researcher
Anastasia Georgiades, Ph.D. She presented the results of the
Duke analysis on Friday, March 9, 2007, at the annual meeting
of the American Psychosomatic Society, in Budapest, Hungary.
"Our data appear to show an important interaction between type
2 diabetes and depression, meaning that physicians should
closely monitor their heart patients who have both of these
disorders.

"There is some sort of synergistic effect between type 2
diabetes and depression that we don't fully understand,"
Georgiades said. "In our analysis, we controlled for factors
that could influence mortality, such as heart disease severity
and age. For whatever reasons, these patients were still at
higher risk of dying, and future research will aim to
investigate the mechanisms for this association."

The research was supported by the National Heart, Lung,
Blood Institute.

The researchers followed 933 heart patients for more than
four years and correlated the 135 deaths that occurred during
that period with the presence of type 2 diabetes and depression
alone and together.

Georgiades said there are some possible explanations for the
link between depression and diabetes.

"Patients with type 2 diabetes typically have an extensive
self-care regimen involving special diet, medications, exercise
and numerous appointments with their doctor," she said. "It may
be that such patients who are depressed might not be as
motivated to carry out all these activities, thereby putting
them at higher risk."

Depression has also been linked to other cardiovascular risk
factors such as insulin resistance, hypertension, obesity,
increased cigarette smoking, alcohol abuse and physical
inactivity.

Other Duke researchers who participated in the study
included James Blumenthal, Charles McCants, Jonathan Davidson,
Michael Babyak, Corrie Bauer, Michael Sketch, Richard Surwit
and senior team member Lana Watkins.