Depression as a Stroke Risk Factor
A systematic review and meta-analysis finds that depression increases the risk for stroke.
Although depression is clearly linked with increased rates of incident cardiovascular risk factors and cardiovascular disease, its relation to incident stroke has not been as well defined. Now, researchers have conducted a systematic review and meta-analysis of prospective cohort studies evaluating the relation between baseline depression and risk for subsequent stroke.
Among 28 eligible studies involving 317,540 adults followed for 2 to 29 years, 8478 incident strokes were identified. The interstudy heterogeneity was moderate to high. In most studies, investigators assessed depression via self-reported scales, measured depression only at baseline, studied U.S. or European cohorts, and obtained data on stroke from death certificates or medical records. Compared with nondepressed participants, those with depression had a 45% higher risk for stroke, a 55% higher risk for fatal stroke (evaluated in 8 studies), and a 25% higher risk for ischemic stroke (evaluated in 6 studies). The relative risks for nonfatal and hemorrhagic stroke in depressed participants (evaluated in 3 and 2 studies, respectively) were not statistically significant. Sensitivity analyses, including accounting for baseline history of stroke, left results essentially unchanged. The authors estimated that 106 total strokes, 53 ischemic strokes, and 22 fatal strokes per 100,000 individuals per year in the U.S. are attributable to depression.
Comment: This large and rigorous study provides the most compelling evidence to date that depression a prevalent and pervasive problem confers a significant and substantial risk for stroke. Presumably, depression could lead to stroke via several mechanisms, including prothrombotic and proinflammatory effects, but more studies are needed to clarify whether depression is causal or simply a marker for stroke. Meanwhile, prudent clinicians may want to routinely screen for and treat clinical depression in patients with or at risk for stroke, particularly because depression is related to known lifestyle risk factors for stroke, such as sedentariness, smoking, sleep inadequacy, and medication noncompliance.
Bruce Ovbiagele, MD, MS
Published in Journal Watch Neurology November 1, 2011
Pan A et al. Depression and risk of stroke morbidity and mortality: A meta-analysis and systematic review. JAMA 2011 Sep 21; 306:1241. [Medline ® Abstract]
Copyright © 2011. Massachusetts Medical Society. All rights reserved.
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