Key result
Depression is best conceptualized as a non-causal variable risk marker for coronary heart disease rather than a causal risk factor, as its association is likely confounded by cardiac disease severity.
Depression is likely a non-causal variable risk marker for coronary heart disease, with the association largely confounded by underlying cardiac disease severity.
Depression screening in CHD should continue without causal assumptions; leaves open whether interventions improve outcomes independent of cardiac severity.
BACKGROUND: After decades of investigations, explanations for the prospective association between depression and coronary heart disease (CHD) are still incomplete. DISCUSSION: Depression is often suggested to be causally related to CHD. Based on the available literature, we would rather argue that depression can best be regarded as a variable risk marker, that is, a variable that fluctuates together with mechanisms leading to poor cardiovascular fitness. Despite numerous efforts, no evidence is found that manipulation of depression alters cardiovascular outcomes--a key premise for determining causality. To explain the concept of a variable risk marker, we discuss several studies on the heterogeneity of depression suggesting that depression is particularly harmful for the course of cardiovascular disease when it appears to be a physiological consequence of the cardiovascular disease itself. SUMMARY: We conclude that instead of depression being a causal risk factor for CHD, the association between depression and CHD is likely confounded, at least by the cardiac disease itself.
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Meijer et al. (2013) conducted a review in Coronary heart disease and depression. Depression vs. No depression was evaluated. Depression is best conceptualized as a non-causal variable risk marker for coronary heart disease rather than a causal risk factor, as its association is likely confounded by cardiac disease severity.
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