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Comorbid Depression is Associated with Increased Major Adverse Limb Events in Peripheral Arterial Disease: A
Joanne G Abi-Jaoudé1, Ahmed A Naiem2, Thomas Edwards3
1Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.
Insights
Depression in peripheral arterial disease (PAD) patients increases major adverse limb events by 20%. Further research is needed to understand this link and associated comorbidities.
Area of Science:
- Cardiovascular Medicine
- Psychiatry
- Public Health
Background:
- Depression is a known risk factor for adverse outcomes in coronary artery disease.
- Research on depression's impact on peripheral arterial disease (PAD) outcomes is limited.
- This review systematically evaluates the literature on depression and PAD.
Purpose of the Study:
- To systematically review and meta-analyze the impact of comorbid depression on adverse outcomes in patients with peripheral arterial disease (PAD).
- To identify specific adverse outcomes associated with depression in PAD patients, including mortality, major adverse cardiovascular events (MACE), and major adverse limb events (MALE).
Main Methods:
- Systematic review and meta-analysis of studies from MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library (inception to July 2021).
- Included studies compared depressed and non-depressed patients with PAD.
- Outcomes assessed were death, MACE, and MALE.
Main Results:
- Seven studies were identified from 9,297 articles.
- Depressed PAD patients were more likely to be female, diabetic, smokers, and have chronic limb-threatening ischemia.
- A 20% increased risk of major adverse limb events (MALE) was observed in depressed patients (RR 1.20; 95% CI 1.11-1.31).
- No significant increased risk of death (RR 1.03; 95% CI 0.72-1.40) or MACE (RR 1.16; 95% CI 0.67-2.01) was found.
- Meta-regression did not identify significant contributions from comorbidities or demographics to the MALE risk ratio.
Conclusions:
- Depression affects 13% of PAD patients and is linked to increased medical comorbidity and a 20% higher risk of MALE.
- The strength of the current evidence is very low, highlighting the limited state of research.
- Future prospective studies should investigate the impact of depression, its relationship with comorbidities, and high-risk health behaviors in PAD.
Objective:
Depression is a significant risk factor for death in coronary artery disease. Conversely, the research surrounding depression and peripheral arterial disease is limited. This review aimed to systematically evaluate the available literature on the impact of comorbid depression on adverse outcomes in peripheral arterial disease.
Data Sources:
A systematic review and meta-analysis were performed using the following databases MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library from inception until July 2021.
Review Methods:
Included studies compared depressed and non-depressed patients with peripheral arterial disease. The outcomes included death, major adverse cardiovascular events, and major adverse limb events.
Results:
A total of 9 297 articles were searched. Of these, seven studies were identified. Depressed patients were more likely to be women, diabetic, have a history of smoking, and have chronic limb threatening ischaemia, despite being younger than non-depressed patients. There was a 20% increase in major adverse limb events in depressed patients (RR 1.20, 95% CI 1.11 - 1.31, z = 3.9, p < .001, GRADE strength: very low) but no increased risk of death (RR 1.03, 95% CI 0.72 - 1.40, z = 0.06, p = .95, GRADE strength: very low) or major adverse cardiovascular events (RR 1.16, 95% CI 0.67 - 2.01, z = 0.54, p = .59, GRADE strength: very low). A follow up meta-regression of various comorbidities and demographic variables did not demonstrate a significant contribution to the observed risk ratio for major adverse limb events.
Conclusion:
Depression was reported in 13% of patients with peripheral arterial disease, associated with more medical comorbidity, and a 20% increased risk of major adverse limb events. Although the strength of this evidence is very low, the current state of the literature remains limited. Future studies should prospectively assess the impact of depression and its relationship to medical comorbidities and high risk health behaviours.
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