Depressive Symptoms and 24-Hour Urinary Norepinephrine Excretion Levels in Patients with Coronary Disease

Findings from the Heart and Soul Study

The Heart and Soul Study considers the psychosocial factors and health outcomes in patients with coronary disease. Depressive symptoms have been associated with an increased risk of cardiac events in patients with heart disease. The goal of this study was to examine the association between depressive symptoms and 24-hour urinary norepinephrine, epinephrine, and dopamine excretion levels in 598 patients with coronary heart disease. Depressive symptoms were measured using the nine-item Patient Health Questionnaire, a self-report checklist of depressive symptoms derived from the Primary Care Evaluation of Mental Disorders interview. The study found that depressive symptoms were not associated with abnormal urinary levels of epinephrine or dopamine excretion. However, 9.4 percent of the participants with depressive symptoms had a norepinephrine value above the normal range. This association persisted after adjustment for age, sex, body mass index, smoking, urinary creatinine levels, comorbid illness, medication use, physical activity and cardiac function. Future research is needed to determine whether increased levels of norepinephrine lead to a higher risk of cardiac events in patients with depressive symptoms.