Effect of modernized collaborative care for depression on depressive symptoms and cardiovascular disease risk biomarkers: eIMPACT randomized controlled trial

•Our modernized depression intervention used internet and telephonic psychotherapy.•Intervention participants exhibited meaningful improvements in depressive symptoms.•Successful depression treatment did not reduce cardiovascular risk biomarkers.•Depression treatment is not sufficient to lower cardiovascular risk in depression.•Integrated care should harness technology to maximize access/minimize resources. Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income