Systematic review and individual patient data meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction: a MINDMAPS study

Objective - Using combined individual patient data (IPD) from prospective studies, we explored sex differences in depression and prognosis post-myocardial infarction (MI), and determined whether disease indices could account for found differences. Methods - Meta-analysis of IPD from 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies of MI patients, identified by systematic review for the MINDMAPS study. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent cardiovascular morbidity and all-cause mortality. Results - Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted OR=0.68, 95% CI 0.60 to 0.77, p (sex*depression interaction p Conclusions - The prevalence of depression post-MI was higher in women than men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only, and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may in part reflect cardiovascular disease severity

Adjusted prognostic association of post-myocardial infarction depression withmortality and cardiovascular events: an individual patient data meta-analysis

Background: The association between depression after myocardial infarction (post-MI) and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity. Aims: To combine original data from studies on the association between post-MI depression and prognosis into one database. To investigate to what extent post-MI depression predicts prognosis independently of disease severity. Method: Individual patient data meta-analysis of studies, using multilevel, multivariable Cox regression analyses. Results:Sixteen studies participated, creating a database of 10,175 post-MI patients. HRs for post-MI depression were 1.32 (95%CI 1.26-1.38, p Conclusions: The association between post-MI depression and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score. Declaration of interest: None

Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction:Heterogeneity across age and sex subgroups

Background:  Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients. Methods:  Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean= 3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (= 55, 56-69 and = 70 years) and sex for symptoms that potentially interacted with age and sex. Results:  At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR: 1.20; 95% CI: 1.11-1.28, p 70. Fatigue was associated with mortality in women aged 56-69 (HR: 1.54; 1.09-2.15; p=. 012), and suicidal ideation in women aged > 70 (HR: 1.58; 1.03-2.43; p=. 037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men = 70 years. Limitations: Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment. Conclusions:  There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups