Association of Depression with Subclinical Coronary Atherosclerosis: a Systematic Review

To assess causal association of depression with subclinical coronary atherosclerosis, we performed computer-based and manual search of literature for studies which had assessed relationship of depression disorder with coronary atherosclerosis. All studies had diagnosed depression with validated tools in patients without diagnosed coronary artery disease. The Bradford Hill criteria of cause–effect association was consistently fulfilled by those studies which achieved statistical significance and further showed incremental strength of association with one or more of the following attributes: (1) prospective cohort study, met cause–effect criteria of “temporality”; (2) relatively severe and/or longer period of depression, met cause–effect criteria of “dose–response”; (3) depression with predominantly somatic symptoms cluster, met cause–effect criteria of “scientific plausibility”; (4) multiethnic larger sample, met cause–effect criteria of “population equivalence”; and (5) multicenter study, met criteria of “environmental equivalence.” Our results show that there is a significant association of depression with coronary atherosclerosis at its subclinical stages.