Abstract
Objective
To examine the association of comorbid occurrence of diabetes and depression with
risk of cardiovascular endpoints including cardiovascular mortality, coronary heart
disease and stroke.
Research design and methods
A systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane
Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality
associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios
were calculated using random- effects models.
Results
Nine studies met the inclusion criteria. The combined pooled hazard ratios showed
a significant association of cardiac events in people with depression and type 2 diabetes,
compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled
hazard ratio was 1.48 (95% CI: 1.185, 1.845), p = 0.001, for coronary heart disease
1.37 (1.165, 1.605), p < 0.001 and for stroke 1.33 (1.291, 1.369), p < 0.001. Heterogeneity
was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower
for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively).
Meta-regression analyses showed that depression was not significantly associated with
the study level covariates mean age, duration of diabetes, length of follow-up, BMI,
sex and ethnicity (p < 0.05 for all models). Only three studies were found that examined
the association of depression in type 1 diabetes, there was a high degree of heterogeneity
and data synthesis was not conducted for these studies.
Conclusions
We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase
in coronary heart disease and 32.9% increase in stroke in people with diabetes and
comorbid depression. The presence of depression in a person with diabetes should trigger
the consideration of evidence-based therapies for cardiovascular disease prevention
irrespective of the baseline risk of cardiovascular disease or duration of diabetes.
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Article info
Publication history
Published online: August 14, 2019
Accepted:
August 12,
2019
Received in revised form:
July 23,
2019
Received:
June 16,
2019
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier B.V. All rights reserved.
