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To the Editor: Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease. In the Heart and Soul Study, Dr Whooley and colleagues¹ demonstrated that the association between depressive symptoms and adverse cardiovascular events appears to be mediated by behavioral factors, particularly physical inactivity.

The observational Health in Men Study² suggested an association between depression and high homocysteine concentration. Other studies have shown an association of depression with B₁₂ and folate deficiency.^2-3 Homocysteine level is a marker of deficiency of B₁₂ and folate, and patients with depression have increased levels of homocysteine.²

There is also an increased prevalence of cardiovascular disease in older men, and homocysteine is considered a sensitive marker of cardiovascular disease.⁴ A meta-analysis suggested a causal association between homocysteine and cardiovascular disease.⁵ Lowering homocysteine concentrations by 0.41 mg/L (to convert to µmol/L, multiply by 7.397) (achievable by increasing folic acid intake) may be associated with . . . [Full Text of this Article]

Parkavi Chellappa, MD
Department of Psychiatry

Radhakrishnan Ramaraj, MD
drkutty2@gmail.com
Department of Internal Medicine
University of Arizona College of Medicine
Tucson

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RELATED ARTICLE

Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
Mary A. Whooley, Peter de Jonge, Eric Vittinghoff, Christian Otte, Rudolf Moos, Robert M. Carney, Sadia Ali, Sunaina Dowray, Beeya Na, Mitchell D. Feldman, Nelson B. Schiller, and Warren S. Browner
JAMA. 2008;300(20):2379-2388.
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RELATED LETTER

Depression, Homocysteine Concentration, and Cardiovascular Events—Reply
Mary A. Whooley
JAMA. 2009;301(15):1542.
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