Researchers from the National Cardiovascular Research Network (funded by Health and Care Research Wales and British Heart Foundation) and Swansea University have uncovered that patients with depression are more likely to receive vital heart disease risk checks and treatments than those without.  

However, major gaps in cardiovascular prevention remain across Wales. The British Heart Foundation has invested approximately £1M, alongside a Welsh government investment of £2M, over five years to build cardiovascular research capacity in Wales to address cardiovascular health challenges in Wales and the wider population. 

The findings come from a major population-level study, funded by British Heart Foundation, analysing millions of electronic health records in Wales and highlight an urgent need for system-level improvements. 

Key findings: 

• Patients with depression were more likely to have their blood pressure and cholesterol checked and cardiovascular risk scores calculated than those without depression. 

• They were also more likely to be prescribed blood‑pressure medication and achieve healthy blood‑pressure control, especially women. 

• However, despite being more likely to receive cholesterol‑lowering drugs, patients with depression were no more likely than others to reach healthy LDL cholesterol targets. 

• Young men are far less likely to be tested for heart disease, potentially missing early detection. 

• Worryingly, routine risk‑factor testing remains low across Wales, especially lipid testing, and many patients on treatment receive no follow‑up checks. 

• People with depression develop cardiovascular disease around 11 years earlier on average than those without – a major unanswered question. 

What This Means 

It is encouraging that patients with depression are not being overlooked compared to those free from depression and anxiety, in fact they receive slightly more effective heart‑health monitoring. However, the overall system is still missing opportunities to prevent heart disease which is common and presents at a much earlier age in patients with mental illness. Many patients are prescribed medication without regular monitoring, with key risk factors, especially cholesterol, not being tested widely enough. 

More detail:  

People with depression are getting heart disease risk factors checked more often than those without depression 

• Data from 2.29 million Welsh patients found that individuals with depression were more likely to have their blood pressure, cholesterol and QRISK scores assessed.  

• Younger women are more likely to have their blood pressure measured 

• Men are more likely than women to receive lipid tests regardless of depression status 

• It suggests that the increased healthcare contact associated with depression may actually create opportunities for earlier detection of physical‑health risks. 

• However, the study also showed that overall lipid testing and QRISK documentation were low across the population, meaning many people, depressed or not, are still missing important preventative checks. 

Depressed patients were more likely to be prescribed blood pressure medication, but there are major concerns 

• Across nearly 290,000 patients with hypertension, those with depression were more likely to receive antihypertensive therapy and more likely to have controlled blood pressure within a year than patients without depression. Women with depression achieved the best control rates. 

• Only 76% of people with longstanding hypertension had a follow‑up blood‑pressure reading within a year of follow up in the study. 

• In newly diagnosed patients, this fell to just 37% within a year of diagnosis, meaning most had no documented BP check after diagnosis. 

• This reveals a system‑wide issue in ongoing monitoring, not limited to the depressed population. 

Cholesterol treatment is poor across Wales – even when prescribed more often to people with depression 

• A study of 56,463 patients with atherosclerotic cardiovascular disease (ASCVD) found that patients with depression were more likely to be prescribed lipid‑lowering therapy, but no more likely to achieve guideline LDL‑cholesterol targets – even when on treatment. 

• Fewer than one‑third received guideline‑recommended cholesterol‑lowering therapy within six months of diagnosis. 

• Strikingly, patients with a history of depression developed ASCVD 11 years earlier on average than those without depression, despite having fewer traditional risk factors such as diabetes or high blood pressure. 

Things to note:  

Risk‑factor testing is too low across the whole population. Lipid testing is insufficient, which prevents clinicians from identifying and treating high‑risk individuals early. Whilst these findings are concerning, international studies show that cardiovascular risk factor testing and treatment is less than optimal in most populations, with this study providing more granular information regarding the “state of play” in relation to patients with mental health conditions. 

Follow‑up after medication is inconsistent. Patients are often prescribed therapy but not monitored to see if treatment is working, especially for lipids and in younger men. 

Earlier onset of heart disease in depression remains unexplained. Even with more frequent checks and treatment, people with depression develop ASCVD far earlier. This suggests a potential combination of biological vulnerability, socioeconomic challenges, lifestyle factors, or undertreatment intensity. 

Healthcare needs to be easily accessible to people regardless of age, gender and where they live. Young women are widely tested for blood pressure, but treatment patterns vary. But young men are far less likely to be tested for heart disease, potentially missing early detection. 

Quotes:  

Dr Libby Ellins, Lead Author: “Whilst it was reassuring to see that patients with depression are having their risk factors assessed, treated and controlled at least as well, in some cases better than those without depression. The research highlighted that there is still more to do to understand why those with depression are at greater risk of developing heart disease and how better to improve their outlook.”  

Professor Julian Halcox, Co-author: “We undertook this study to see whether patients with depression received less effective management of their cardiovascular risk factors in routine clinical care in Wales, to see if this could go some way to explaining the higher risk of heart disease and cardiovascular death in these patients. Indeed, we saw that patients with a diagnosis of depression were diagnosed with cardiovascular disease over ten years earlier on average than those without. We were encouraged to see that testing, treatment and control of blood pressure and cholesterol levels was no worse (in some cases better) in patients with depression. However, the overall effectiveness of management of these risk factors in our All-Wales study was well below that recommended by UK and International Guidelines, suggesting that more effective and accountable delivery systems are required to address these gaps in preventive care at a population level.”  

Dr Sonya Babu-Narayan, Associate Medical Director at British Heart Foundation: “It’s encouraging to see that people with depression are having their cardiovascular risk factors checked and treated at least as well as, and sometimes better than, those without depression. But these findings do not leave room for complacency. We need more research to understand better the link between living with depression and the higher chance of being diagnosed with risk factors for heart disease. Clearly there is more work to do to ensure heart health management in Wales meets international standards so that more lives can be saved.” 

Professor Chris George, Director of the National Cardiovascular Research Network: “We know that one in three of us will die from cardiovascular disease and that depression poses major societal and healthcare challenges. The work of Dr. Ellins and her colleagues shines a light on the links between these two diseases and it’s vitally important that further work is done in this area. We look forward to supporting Dr. Ellins’s research helping to improve our understanding of cardiovascular disease risk profiling in the population.”