New research warns that heart disease along with deep depression and high stress is a deadly combination that might lead to earlier deaths among persons with heart disease.

Doctors are calling this lethal combination the "psychosocial perfect storm".

The study looked into the effect of significant stress and deep depression in some 4,500 patients with heart disease.

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"We found that those who reported both high stress and high depression were 48 percent more likely than those with low stress and low depression to have another heart attack or die in the first 2.5 years of follow-up," said lead researcher Carmela Alcantara, an associate research scientist at Columbia University Medical Center in New York City.

"The combination of high stress and high depression symptoms may be particularly harmful for adults with heart disease during an early vulnerability period," she noted.

The research revealed people with both stress and depression were likely to report recent crying spells. They also feel they can't handle personal problems and are helpless in the face of overwhelming difficulties.

High stress alone, or depression alone, didn't increase the risk of another heart attack or death, she said.

Alcantara and colleagues collected data on 4,487 heart disease patients, aged 45 and older, enrolled in the Reasons for Geographic and Racial Differences in Stroke study.

Interviewed in their homes, participants were asked how often they felt depressed, lonely or sad, or had crying spells during the past week.

They were also asked how often they felt unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way during the past month.

Over an average six years of follow-up, 1,337 participants died or had a heart attack. The risk was 48 percent higher for those with stress and serious depression than those not feeling emotionally drained, but only for the first 2.5 years.

The report was published March 10 online in the journal, Circulation.