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
Chellappa P, Ramaraj R. Depression, Homocysteine Concentration, and Cardiovascular Events. JAMA. 2009;301(15):1541-1542. doi:10.1001/jama.2009.490