A study of more than one thousand men and women with heart disease has found depression to be associated with an increased risk of peripheral artery disease (PAD).

PAD is a circulatory problem in which narrowed arteries reduce blood flow to the limbs usually the legs and feet resulting in pain, reduced mobility and, in extreme cases, gangrene and amputation.


Marlene Grenon, MD, CM, a vascular surgeon at San Francisco VA Medical Center and the University of California (SFVAMC) and an assistant professor of Surgery at UCSF, led the analysis of data from 1,024 participants in the Heart and Soul Study, a prospective study of men and women with coronary artery disease who were followed for an average of approximately seven years.

"We discovered that there was an association between depression and PAD at baseline, and also found that the patients who were depressed at the beginning of the study had a higher likelihood of developing PAD during follow-up at seven years," said Grenon.

The researchers found that some of the risk for PAD was partly explained by modifiable risk factors such as smoking and reduced physical activity.

"We still don't know which comes first. Is it that patients with PAD become depressed because their mobility is impaired, or that people who are depressed engage in unhealthy behaviours such as smoking and lack of exercise, and are thus more at risk of developing PAD? Or might it be a vicious cycle, where one leads to the other? " said Grenon.

Further research is needed to tease out cause and effect, she said.

The study authors suggest that whatever the initial cause, lifestyle modifications such as being more physically active, eating better, quitting smoking and managing stress more effectively might reduce the risk for the association, as well as potentially address symptoms of both PAD and depression.

The study was published last month in the Journal of the American Heart Association.