Submitted by Dr. Anton Safer, Sep 30, 2008 08:28

The link between depression and cardiac diseases like coronary artery disease (CAD) and chronic heart failure (CHF) has been observed about 30 years ago. Evidence from clinical studies is there in increasing number since begin of the 90ies. The vitious circle also works the other way: people that are in deep grief (loss of partner or children, chronic exhaustion, burnout syndrome from work stress) frequently fall into depression. If the depression remains undiagnosed or untreated it can lead to development of CAD, CHF, myocardial infarction or stroke quite fast. As Phyllis Stein's investigations at the Washington University School of Medicine have shown, there is a causal relationship that is driven by the depression. Relative risk of sudden death is elevated at least fivefold by depression. Therefore, understanding the patient's situation, getting to the right diagnoses and directing the treatment resources to the root causes of the disease process is so essential for restitution of patients healths. What you did not mention is a third area of diseases, namely diabetes. Most of the diabetic patients develop CAD and some also CHF during the progression of diabetes, specifically if not well controlled and balanced. The prevalence of obesity leads to a fast-growing epidemic not only of type-2 diabetes, but also to these cardiac diseases, diabetic retinopathy (visual impairment) and nephropathy (loss of kidney function). Health care policy has no adequate answer to meet these challenges and reverse the trend to an elder and more and more overweight, but even at younger ages sicker population. Integrative medical approaches and a policy change to preventive medical strategies - these are the challenges for the future. Any health care reform will fail that neglects these essential principles. Ignorance costs lives!

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