Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction

Abstract

The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.

Longitudinal modelling of theory-based depressive vulnerabilities, depression trajectories and poor outcomes post-ACS

“…The lack of mediation here may be explained by the depression scales used in the present study, which omitted somatic items, and these items may be more related to disease indices than other items (de Miranda Azevedo et al, 2014). It is surprising that sex was not a significant predictor of depression trajectories, in contrast to current literature (Doyle et al, 2015). Again, however, it is possible that scales used may account for these findings.…”

“…Choice of risk factors to include in the expanded path analysis was determined through a multivariate logistic regression analysis of significant demographic and disease predictors of outcome. Sex and left ventricular function were added to model two as recent findings indicated these are important determinants of depression and sex differences in prognosis post-MI (Doyle et al, 2015). To avoid overfitting, further adjustments were not made.…”

“…In general, the literature shows that these conditions are inextricably linked in several ways. Meta-analyses have shown not only elevated levels of depressive symptoms post-ACS, but also that these symptoms are associated with poorer prognosis (Doyle et al, 2015;Meijer et al, 2011). A more recent individual patient data meta-analysis of 10,175 post-MI patients showed that depressive symptoms led to an increased risk of mortality 32% per standard deviation increase in depressive symptoms, when adjusting for age and sex (Meijer et al, 2013a).…”

Management of Depression After Myocardial Infarction

“…Depression is common in patients with coronary heart disease, and many studies agree on a prevalence of 15-20 % for major depressive disorder in patients who have had a myocardial infarction [6][7][8]; a recent review and meta-analysis suggests even higher prevalence when considering both diagnosis of major depressive disorder and elevated depression symptoms [9]. Depression is associated with a high level of disability, and, particularly, when it begins following a coronary event and is persistent over time, is associated with substantially increased cardiac morbidity and mortality in patients who have had a myocardial infarction [10, 11, 12••].…”

Exploring Cognitive Concomitants of Mental Fatigue in Patients with Coronary Artery Disease

“…For example, in a study of 1,072 consecutive CAD patients admitted to a cardiac rehabilitation unit, mental fatigue was associated with a worsening of healthrelated quality of life (HRQOL) and poor mental health. Fatigue represents a core symptom of depression, and depression is known to affect clinical outcomes in CAD [4][5][6], Therefore, the finding that these associations remained constant even after the effect of depression had been controlled suggests that fatigue represents an independent marker of clinical outcomes in CAD patients, separate from depression [7].…”