The role of depression in the primary prevention of cardiovascular disease

Hans G Stampfer, Dana A Hince and Simon B Dimmitt
Med J Aust 2013; 198 (7): . || doi: 10.5694/mja12.11637
Published online: 15 April 2013

To the Editor: We would like to add a cautionary note to O’Neil’s support for the inclusion of “depression and other psychosocial factors” in the updated National Vascular Disease Prevention Alliance guidelines for assessing cardiovascular disease (CVD) risk. Her statement “it is now clear that depression is also an important risk factor for CVD” is premature.1 Different authors have challenged the suggested relationship and, given divergent findings and opinions, it is misleading to claim that the matter is now “clear”.2-5 We do not deny a possible link between depression and coronary heart disease (CHD) but suggest that the extent and nature of the relationship has yet to be clarified. Premature acceptance and promotion of the idea that depression is a risk factor for CHD might contribute to overdiagnosis and overtreatment of depression as well as undue worry about the risk of CHD by individuals diagnosed with depression.

  • University of Western Australia, Perth, WA.


Competing interests:

No relevant disclosures.

  • 1. O’Neil AE. The role of depression in the primary prevention of cardiovascular disease. Med J Aust 2012; 197: 444-445. <MJA full text>
  • 2. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006; 27: 2763-2774.
  • 3. Kuper H, Nicholson A, Kivimaki M, et al. Evaluating the causal relevance of diverse risk markers: horizontal systematic review. BMJ 2009; 339: b4265.
  • 4. Wulsin LR. Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harv Rev Psychiatry 2004; 12: 79-93.
  • 5. Stampfer HG, Hince DA, Dimmitt SB. Depression as a risk factor for coronary heart disease – how strong is the evidence? O J Psych 2012; 2: 284-291.


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