Association Between Myocardial Infarction and Depression: Bidirectional Links and Shared Risk Pathways-A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies.
PubMed 41967088 · doi:10.1093/eurjpc/zwag206
What was done
A systematic review and random-effects meta-analysis was conducted across PubMed, Embase, and PsycINFO (from inception to 31 December 2025) of prospective cohort and longitudinal studies reporting adjusted hazard ratios (HRs) for the bidirectional association between myocardial infarction (MI) and depression. Study quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity was assessed with the I2 statistic. Subgroup analyses by age and sex, sensitivity analyses, and exploratory analyses of antidepressant classes and shared comorbidities were performed.
What was found
Nine population-based cohort studies were included: - MI was associated with an increased risk of subsequent depression: pooled adjusted HR 1.41 (95% CI 1.24–1.61; I2 = 0%; 2 studies). - Depression was associated with an increased risk of incident MI: pooled adjusted HR 1.42 (95% CI 1.29–1.57; I2 = 84.7%; 8 studies). - Stronger relative associations were observed in younger individuals, alongside sex-specific differences. - Sparse evidence showed tricyclic antidepressant use was associated with higher MI risk, whereas selective serotonin reuptake inhibitors were not. - Multiple shared cardiometabolic (diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, chronic kidney disease) and psychiatric (anxiety, PTSD) comorbidities were reported.
Why it matters
This review demonstrates a clear bidirectional risk between depression and myocardial infarction, emphasizing the need for integrated cardiometabolic and mental health assessments in clinical practice.
Limits
Only two studies evaluated the temporal direction from MI to subsequent depression. Substantial heterogeneity (I2 = 84.7%) was present in studies assessing depression leading to MI. The total number of individual participants was not reported in the abstract, and antidepressant analyses were exploratory based on sparse data.
Cited by
- supports Cardiovascular disease and depression frequently co-occur as comorbidities.