Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis

Farooqi, Aaisha; Khunti, Kamlesh; Abner, Sophia C.; Gillies, Clare; Morriss, Richard; Seidu, Sam

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.

• Journal Article Type: Article
• Acceptance Date: Aug 12, 2019
• Online Publication Date: Aug 14, 2019
• Publication Date: 2019-10
• Deposit Date: Aug 29, 2019
• Publicly Available Date: Aug 15, 2020
• Journal: Diabetes Research and Clinical Practice
• Print ISSN: 0168-8227
• Electronic ISSN: 1872-8227
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 156
• Article Number: 107816
• DOI: https://doi.org/10.1016/j.diabres.2019.107816
• Keywords: Internal Medicine; Endocrinology, Diabetes and Metabolism; Endocrinology; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2514890
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0168822719308265
• Additional Information: This article is maintained by: Elsevier; Article Title: Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis; Journal Title: Diabetes Research and Clinical Practice; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.diabres.2019.107816; Content Type: article; Copyright: Crown Copyright © 2019 Published by Elsevier B.V. All rights reserved.