Heart Disease Takes Toll

Blacks and whites with heart disease are both likely to experience depression, but blacks are only half as likely to receive treatment for the disorder, according to a study from Duke Medical Center. "This is an important finding because we know that depression is associated with a two- to four-fold increase in the risk of complications and death from heart disease," says James Blumenthal, a professor of medical psychology and a co-author of the study, which appears in the American Heart Journal.

Coronary heart disease is the leading cause of death in the U.S., and previous studies show that it takes a disproportionate toll among blacks.

Duke researchers studied 864 patients (727 whites and 137 blacks) who received care at the Duke Heart Center's diagnostic cardiac catheterization laboratory between April 1999 and June 2002. Researchers reviewed the patients' records, noting use of medications and any cardiovascular risk factors. They also asked participants to complete the Beck Depression Inventory to assess symptoms of depression.

The scientists found that 35 percent of the black patients and 27 percent of the white patients had elevated symptoms of depression. But while 21 percent of the whites were taking antidepressants, only 11.7 percent of the blacks were receiving treatment.

There also appeared to be important gender differences. Among those with the most severe symptoms of depression, 43 percent of white men but only 22 percent of black men were on antidepressants. In comparison, 64 percent of white women and 67 percent of black women were taking such medications.

Available data do not provide a clear explanation for the disparity in treatment rates, Blumenthal says. Possible explanations include patients' fear of stigmatization and inability to pay out-of-pocket expenses.