Depression and Risk of New-Onset Cardiovascular Disease: An Updated Systematic Review and Meta-Analysis

Abstract

Objective: There is growing evidence indicating a bidirectional relationship between depression and cardiovascular diseases (CVDs). Among the limitations of previous studies include the use of a single baseline measure of depressive symptoms. Objective: To establish whether an independent association with CVD exists for depression either measured at baseline or at multiple instances in a population free of CVD and cerebrovascular diseases. Design and method: Bibliographic databases were searched from 2005 up to 2019 using Medline, EMBASE, Web of Science and PsycINFO without language restrictions. Prospective cohort studies which reported the association between depression and incidence of three CVD outcomes (stroke, coronary heart disease (CHD), myocardial infarction (MI) and heart failure (HF)) were included. Pooled hazard ratios (HR) were calculated using inverse variance method in random effect models. Results: Twenty-two prospective cohorts with 43 independent reports were identified, of which twenty were suitable for meta-analysis with a total of 3,642,913 participants and an average follow-up of 10 years. Participants with depressive symptoms at baseline had a 25% higher risk of stroke (HR = 1.25 95%CI 1.11–1.40, I2 = 67%), a 20% higher risk of CHD (HR = 1.20 95%CI 1.08–1.32, I2 = 82%) and a 24% higher risk of MI (HR 1.24 95%CI 1.20–1.28, I2 = 0%) comparing to participants without depressive symptoms at study entry. Similar associations were observed after restricting analysis to studies that measured depression as a time-varying exposure - stroke (HR = 1.32 95%CI 1.10–1.59, I2 = 0%) and CHD (HR = 1.21 95%CI 1.02–1.43, I2 = 34%). Two studies reported HF outcomes and this showed a similar association (HR = 1.18 95%CI 1.08–1.29, I2 = 0%). In subgroup-analysis by type of depression assessment, clinical depression appeared to be a stronger predictor than depressive symptoms for stroke and CHD. Conclusions: Depression is associated with increased risk for the development of CVDs.