The role of depression in the primary prevention of cardiovascular disease

Adrienne E O’Neil
Med J Aust 2013; 198 (7): . || doi: 10.5694/mja12.11725
Published online: 15 April 2013

In reply: I thank Stampfer, Hince and Dimmitt for their response. While I acknowledge that there are aspects of the relationship between cardiovascular disease (CVD) and depression that remain undetermined, recent evidence clearly supports the role of depression as an independent risk factor for CVD and is indeed convincing.1-3 This is especially true in studies that assess depression using diagnostic criteria.4 We know that the risk of developing coronary heart disease (CHD) for individuals with depression is twofold, and these individuals have a similar risk of CVD-related death.2 We also know that the independent contribution of depression to CVD is at least comparable to that of more traditional risk factors including diabetes, hypercholesterolaemia, smoking or obesity.5 A decade has now passed since the National Heart Foundation’s seminal position paper concluded that: “there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD”.5 Despite this, depression remains underestimated as a meaningful contributor to CVD.

  • School of Medicine, Deakin University, Geelong, VIC.



I thank Michaela Riddell for feedback on drafts of this letter.

Competing interests:

No relevant disclosures.

  • 1. Majed B, Arveiler D, Bingham A, et al. Depressive symptoms, a time-dependent risk factor for coronary heart disease and stroke in middle-aged men: the PRIME Study. Stroke 2012; 43: 1761-1767.
  • 2. Surtees PG, Wainwright NW, Luben RN, et al. Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry 2008; 165: 515-523.
  • 3. Kendler KS, Gardner CO, Fiske A, Gatz M. Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity. Arch Gen Psychiatry 2009; 66: 857-863.
  • 4. Stampfer HG, Hince DA, Dimmitt SB. Depression as a risk factor for coronary heart disease — how strong is the evidence? O J Psychiatry 2012; 2: 284-291.
  • 5. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust 2003; 178: 272-276. <MJA full text>


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.