The association between depression and coronary artery calcification: A meta-analysis of observational studies

Background and aims: Cardiovascular diseases and depression are responsible for a great global burden of disease; however, the association between depression and coronary artery calcification (CAC) remain controversial and no quantitative meta-analysis exists. Thus, we performed a meta-analysis aimed to evaluate the association between depression and CAC. Methods: We performed a systematic search strategy using PubMed, Web of science, Embase, China National Knowledge Infrastructure and Cochrane library for relevant observational studies investigating depression and CAC from inception until April 2017. The pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) and subgroup analyses were calculated using a random effects model. Results: After screening 411 non-duplicated articles, a total of 15 studies involving 32,884 were included. Our analyses demonstrated a positive association between diagnosed depression and CAC (OR=1.15; 95% CI: 1.04-1.28; I-2 = 80.6), and a non-significant association between depressive symptoms and CAC (OR=1.02; 95% CI: 0.97-1.07; I-2 = 73.5%). In subgroup analysis for cohort studies, the positive association between diagnosed depression and CAC was enhanced (OR = 2.20; 95% CI: 1.33-3.64; I-2 = 0). Conclusions: Our study indicated that diagnosed depression was associated with higher odds of CAC. Systematic screening for CAC may be useful to identify clinically depressed patients at higher risk of future cardiovascular diseases.