European Heart Journal Advance Access originally published online on November 2, 2006
European Heart Journal 2006 27(23):2763-2774; doi:10.1093/eurheartj/ehl338
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Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies
1 Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, UK
2 International Centre for Eye Health, Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Received 12 May 2006; accepted 5 October 2006; online publish-ahead-of-print 2 November 2006.
* Corresponding author. Tel: +44 20 7679 1725; fax: +44 20 7813 0280. E-mail address: amanda.nicholson{at}ucl.ac.uk
Aims With negative treatment trials, the role of depression as an aetiological or prognostic factor in coronary heart disease (CHD) remains controversial. We quantified the effect of depression on CHD, assessing the extent of confounding by coronary risk factors and disease severity.
Methods and results Meta-analysis of cohort studies measuring depression with follow-up for fatal CHD/incident myocardial infarction (aetiological) or all-cause mortality/fatal CHD (prognostic). We searched MEDLINE and Science Citation Index until December 2003. In 21 aetiological studies, the pooled relative risk of future CHD associated with depression was 1.81 (95% CI 1.53–2.15). Adjusted results were included for 11 studies, with adjustment reducing the crude effect marginally from 2.08 (1.69–2.55) to 1.90 (1.49–2.42). In 34 prognostic studies, the pooled relative risk was 1.80 (1.50–2.15). Results adjusted for left ventricular function result were available in only eight studies; and this attenuated the relative risk from 2.18 to 1.53 (1.11–2.10), a 48% reduction. Both aetiological and prognostic studies without adjusted results had lower unadjusted effect sizes than studies from which adjusted results were included (P<0.01).
Conclusion Depression has yet to be established as an independent risk factor for CHD because of incomplete and biased availability of adjustment for conventional risk factors and severity of coronary disease.
Key Words: Meta-analysis • Mortality • Epidemiology • Depression
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