The Heart and Soul Study is a prospective cohort study that was originally designed to determine how depression and other mental health conditions influence the outcomes of patients with coronary heart disease. A total of 1024 participants who were enrolled between September 01, 2000 and December 31, 2002 have been actively followed for more than 20 years. During this time, the Heart and Soul Study has generated more than 180 peer-reviewed publications. Key contributions include demonstrating that:
- Depressive symptoms are more strongly associated with health-related quality of life than objective measures of cardiac disease severity in patients with existing coronary heart disease (JAMA, 2003).
- A simple 2-question instrument can be used to screen for depression in patients with coronary heart disease. A negative test effectively rules out depression so that no further screening is necessary (AJC, 2005).
- The adverse cardiovascular outcomes associated with depressive symptoms are largely explained by poor health behaviors, such as medication non-adherence and physical inactivity (JAMA, 2008). This finding introduced the possibility that the excess risk of cardiovascular events associated with depression could be preventable with behavior modification (such as cardiac rehabilitation).
- Traditional cardiovascular risk factors (including age, sex, body mass index, hypertension, diabetes, and dyslipidemia) do not predict secondary cardiovascular events in patients with existing coronary heart disease (JAHA, 2015). The top four predictors of secondary cardiovascular events are: N-terminal pro-type brain natriuretic peptide, followed by high-sensitivity cardiac troponin T, microalbuminuria, and current smoking.
- Presumably due to advances in therapy, patients with coronary heart disease are now more likely to die from non-cardiovascular than from cardiovascular causes (AJC, 2017).