Vascular Risk Factors and Depression in Later Life: A Systematic Review and Meta-Analysis

doi:10.1016/j.biopsych.2012.10.028

Biological Psychiatry

Volume 73, Issue 5, 1 March 2013, Pages 406-413

https://doi.org/10.1016/j.biopsych.2012.10.028 Get rights and content

Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years; 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27–1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99–1.57), hypertension (OR: 1.14; 95% CI: .94–1.40), or dyslipidemia (OR: 1.08; 95% CI: .91–1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00–1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30–1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52–2.04), and stroke (OR: 2.11; 95% CI: 1.61–2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.

Section snippets

Search Strategy

We systematically searched for studies that investigated the association between VRFs and depression in late life. Studies considering vascular diseases such as coronary heart disease together with VRFs were included, because it is a common feature of risk scales to include previous disease. The MEDLINE, EMBASE, and PsycINFO databases were searched for publications in all languages between 1990 and May 2012. The search terms were: [“depress⁎”] AND [“late life” OR “late onset” OR “older adults”

Results

The literature search identified 1097 studies. Twenty-six studies met the inclusion criteria 29, 30, 31, 32, 33, 35, 37, 38, 39, 41, 44, 46, 54, 55, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79. Their baseline characteristics are summarized in Tables S2 (20 cross-sectional studies) and S3 (6 longitudinal studies) in Supplement 1.

Discussion

The central question of this review was whether VRFs are directly related to LLD or whether the observed relationship is nonspecific. A significant association was found between the composite measure of vascular risk and depression in later life. The positive association also persisted and remained statistically significant across several subgroups stratified by study characteristics, such as study design, source of sample, measures of exposure, and measures of outcome. These results support

Conclusions

We found convincing evidence of a strong relationship between key diseases—such as CVD, diabetes, and stroke—and between composite vascular risk and depression but not between some VRFs (hypertension, smoking, dyslipidemia) and depression. More evidence needs to be accumulated from large longitudinal epidemiological studies that consider biological (vascular and nonvascular), psychological, and social risk factors as well as mediators on their relationship in the context of mechanism-specific

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ReviewVascular Risk Factors and Depression in Later Life: A Systematic Review and Meta-Analysis

Section snippets

Search Strategy

Results

Discussion

Conclusions

Biol Psychiatry

Biol Psychiatry

Am J Geriatr Psychiatry

Psychiatry Res

Psychiatry Res

Biol Psychiatry

Am J Geriatr Psychiatry

Neurosci Biobehav Rev

Biol Psychiatry

Ageing Res Rev

Biol Psychiatry

J Affect Disord

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

J Affect Disord

J Affect Disord

Biol Psychiatry

Biol Psychiatry

Am J Geriatr Psychiatry

J Affect Disord

Am J Geriatr Psychiatry

Eur Geriatr Medicine

Am J Geriatr Psychiatry

J Affect Disord

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Psychiatry Res

Rev Esp Cardiol

J Affect Disord

Biol Psychiatry

Prog Neuropsychopharmacol Biol Psychiatry

Am J Geriatr Psychiatry

Arch Gerontol Geriatr

Prog Neurobiol

Managing depression across the life cycle: New strategies for clinicians and their patients

Intern Med J

A comparison of neurocognitive impairment in younger and older adults with major depression

Psychol Med

Clinically defined vascular depression

Am J Psychiatry

Executive dysfunction in geriatric depression

Am J Psychiatry

The cognitive neuropsychology of depression in the elderly

Psychol Med

The pattern and course of cognitive impairment in late-life depression

Psychol Med

Depressive symptoms and risk of dementia: The Framingham Heart Study

Neurology

Cerebral white matter lesions and depressive symptoms in elderly adults

Arch Gen Psychiatry

Is vascular depression a distinct sub-type of depressive disorder? A review of causal evidence

Int J Geriatr Psychiatry

White matter hyperintensities in late life depression: A systematic review

J Neurol Neurosurg Psychiatry

A magnetic resonance imaging study of white matter lesions in depression and Alzheimer‘s disease

Br J Psychiatry

Review
Vascular Risk Factors and Depression in Later Life: A Systematic Review and Meta-Analysis