Depression ups risk of CVD, mortality

Individuals with depression are at higher risk of developing cardiovascular disease (CVD), which may even result in death, suggests a recent study.

“This meta-analysis demonstrated a significant association between the presence of depression and subsequent development of CVD, as well as cardiovascular mortality, when compared with nondepressed individuals,” the investigators said.

This meta-analysis examined the incidence of CVD and cardiovascular outcomes among persons with major depressive disorder. Twenty-six studies, including a total of 1,957,621 individuals, met the eligibility criteria.

Depression tended to increase the risk of incident stroke (hazard ratio [HR], 1.13, 95 percent confidence interval [CI], 1.00‒1.28), myocardial infarction (HR, 1.28, 95 percent CI, 1.14‒1.45), congestive heart failure (HR, 1.04, 95 percent CI, 1.00‒1.09), or CVD (HR, 1.16, 95 percent CI, 1.04‒1.30). [Am J Med 2023;136:881-895]

In addition, depression significantly correlated with a higher risk of all-cause mortality (HR, 1.43, 95 percent CI, 1.27‒1.60), CVD mortality (HR, 1.44, 95 percent CI, 1.27‒1.63), and congestive heart failure mortality (HR, 3.20, 95 percent CI, 1.29‒7.94).

These findings were consistent with those of a meta-analysis in China, which included over 500,000 individuals and reported the association of depression with an increased risk of CVD mortality in Chinese adults. This study, however, was limited by the patient population and methods (questionnaires) used to assess depression. [J Gerontol B Psychol Sci Soc Sci 2014;69:622-632]

“Our meta-analysis was robust because it included a wide range of different patient demographics, comorbidities, and a large number of studies,” the investigators said. “Our meta-analysis showed significant increases in the risk of development of myocardial infarction and all CVD, as well as CVD mortality.”

Mechanisms

Depression may cause the dysregulation of the autonomic nervous system and result in mental stress, which then leads to the activation of cardiac sympathetic nerves. [Med J Aust 2003;178:272-276]

“The activation of these nerves has been shown to lead to decreased blood flow, increased heart rate, left ventricular hypertrophy, myocardial infarction, and sudden cardiac death,” the investigators said. [Circulation 1991;83:II94-II99; Circulation 2003;108:560-565; Circulation 2002;105:2817-2820; Am J Cardiol 1995;76:562-564]

Additionally, depression is associated with dysregulation in the hypothalamic-pituitary axis. Patients with depression have elevated cortisol levels, which tend to increase the risk for developing metabolic syndrome. [Proc Natl Acad Sci USA 2000;97:325-330]

Metabolic syndrome may lead to the development of several irregularities, including glucose intolerance, hyperlipidaemia, and weight gain. [Metabolism 1995;44:38-41; Int J Obes Relat Metab Disord 2000;24:S80-S85]

“All of these factors support the notion that depression may precipitate the development of CVD, as seen within the findings of our meta-analysis,” the investigators said.

“Given the significant association between depression and cardiovascular disease, early identification and treatment of depression may be another avenue of CVD mitigation. An important future avenue of investigation includes the assessment of treated depression on the development of cardiovascular disease,” they added.