Abstract
A critical appraisal is made of the evidence that depression is a causal risk factor for coronary heart disease. PubMed and Science Citation Index were searched for relevant papers. Forty eight papers satisfying inclusion criteria and reporting an association between a measure of depression and a coronary disease outcome were compared in terms of baseline assessment, exposure and endpoint definition, covariates measured and whether changes in, or treatment of, depression was assessed during follow-up. There was considerable variation in the definition of depression and coronary heart disease and contradictory findings are reported. Conventional risk factors for coronary heart disease were not assessed consistently or adequately. Only three of the forty-eight papers gave consideration to the time course of depression during follow-up and prior to study entry. Potentially confounding variables such as anxiety, personality traits and other psychiatric disorders were not taken into consideration in the majority of papers. Treatment of depression during the follow-up period was not mentioned in any of the papers. In light of identified methodological shortcomings and the inconsistent findings reported we suggest that there is as yet no convincing evidence that depression is an independent causal risk factor for coronary heart disease.
Highlights
Systematic reviews and meta-analyses of “quality filtered” prospective studies have repeatedly concluded that depression is a risk factor for coronary heart disease (CHD) [1,2,3,4] and the validity of this conclusion has been challenged [5,6,7,8,9] the majority of published reports support it
Thirty seven percent (37%) of papers included in this review reported a positive result for all relevant endpoints/group analyses, 29% reported mixed results and 33% found no relationship between depression and CHD
No association was found between positive findings and whether CHD/cardiovascular disease (CVD) was excluded at baseline ( 21 = 0.39, p = 0.53) or whether depression was treated as a primary exposure variable or covariate ( 21 = 0.05, p = 0.82)
Summary
Systematic reviews and meta-analyses of “quality filtered” prospective studies have repeatedly concluded that depression is a risk factor for coronary heart disease (CHD) [1,2,3,4] and the validity of this conclusion has been challenged [5,6,7,8,9] the majority of published reports support it. Depression is a high prevalence disorder and the World Health Organization has predicted that by 2020, depression and CHD will be the two leading causes of disabilityadjusted life years in developed countries. If this prediction proves to be correct and depression is a proven risk factor for CHD, it follows that depression will contribute substantially to the incidence of CHD. There is a risk that awareness and endorsement of the suggested link might contribute to an over-diagnosis/treatment of depression and worry about CHD by individuals diagnosed with depression. These consequences would be unfortunate if there was no justification for the endorsement and the aim here is to show that the evidence in support of the suggested link is far from conclusive
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