Depression and Coronary Heart Disease Risk: An Overview of Systematic Reviews

Abstract

A43was to assess the association of the depression as a risk factor for coronary heart disease (CHD) based on prospective studies included in published systematic reviews. Methods: A systematic review to identify systematic reviews was conducted in MEDLINE, Cochrane library and Embase databases, with no limit on the start date until December 2015, using keywords for depression, coronary events and risk factors. The selection of the reviews that included prospective studies was realized by two researchers independently; primary data from prospective studies analyzing the relationship of depression and CHD were extracted. The Hazard Ratios (HRs) were pooled using random effects model. The subgroup analysis was carried out considering fatal CHD, myocardial infarction, gender, and follow-up duration. Results: It was selected twenty one systematic reviews comprising thirty five prospective studies that were extracted. The number of people included in the studies was 900,226. The main differences among the studies were the age, gender, measurement of depression, length of follow-up and CHD fatality. The meta-analysis found that the depression behavior is a risk factor for CHD, although the heterogeneity is substantial. The analysis by subgroup found low heterogeneity for myocardial infarction and fatal CHD. The analysis suggested that depression increases the risk for fatal CHD AND myocardial infarction (HR 1.13 95%CI: 1.06-1.20 and HR 1.29 95%CI: 1.19-1.39, respectively). In the subgroup analysis by length of follow-up, the HR of CHD was 1.24 (95%CI 1.01-1.47) for the studies with less than 15 years of follow-up and 1.18 (95%CI 1.12-1.24) for those with more than 15 years of followup. ConClusions: The results of meta-analysis suggest that depression increases the risk of CHD significantly, although the evidence has substantial heterogeneity. PCV24CardioVasCular risks of ExogEnous TEsTosTEronE usE among mEn: a sysTEmaTiC rEViEw and mETa-analysis