Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
J Affect Disord. 2023 Jan 1;320:169-177. doi: 10.1016/j.jad.2022.09.098. Epub 2022 Sep 28.
Peripheral artery disease (PAD) is highly prevalent and associated with poor outcomes. Depression is a risk factor for adverse outcomes in patients with coronary artery disease. Despite evidence showing that depression is common in patients with PAD, less is known about its association with adverse prognostic outcomes. To address this, we conducted a systematic review and meta-analysis to summarize the association between depression and outcomes in patients with PAD.
We performed a systematic search of eight databases to January 2022 including studies that reported a risk estimate for the association of depression or depressive symptoms with all-cause mortality or major adverse limb events (MALE) in patients with PAD and pooled results in a meta-analysis. Risk of bias was assessed using ROBINS-I.
Of the 7048 articles screened, 5 observational studies with 119,123 patients were included. A total of 16.2 % had depression or depressive symptoms. Depression was associated with a statistically significant increased risk of all-cause mortality (HR 1.24, confidence interval 1.07-1.25, p = .005). The association between depression and MALE was not significant but trended toward a positive association.
Due to lack of data, results were limited by a single study with a large sample size, overrepresentation of men, and lack of information of depression severity or treatment status.
Depression or depressive symptoms are associated with a 24 % increased risk of all-cause mortality in patients with PAD. Future work should explore the mechanisms and directionality of this association and identify depression as an important comorbidity to address for patients with PAD.
PROSPERO CRD 42021223694.
外周动脉疾病（PAD）患病率高，与不良结局相关。抑郁是冠心病患者不良预后的危险因素。尽管有证据表明 PAD 患者中抑郁较为常见，但对其与不良预后结局的关系知之甚少。为解决这一问题，我们进行了系统回顾和荟萃分析，以总结抑郁与 PAD 患者结局之间的关系。
我们对 2022 年 1 月前的八个数据库进行了系统检索，包括报告抑郁或抑郁症状与 PAD 患者全因死亡率或主要不良肢体事件（MALE）之间关联的风险估计的研究，并进行荟萃分析汇总结果。使用 ROBINS-I 评估偏倚风险。
在筛选出的 7048 篇文章中，纳入了 5 项观察性研究，共 119123 名患者。共有 16.2%的患者有抑郁或抑郁症状。抑郁与全因死亡率显著增加相关（HR 1.24，置信区间 1.07-1.25，p=0.005）。抑郁与 MALE 之间的关联没有统计学意义，但呈正相关趋势。
由于缺乏数据，结果仅限于一项具有较大样本量、男性代表性过高且缺乏抑郁严重程度或治疗状况信息的单一研究。
抑郁或抑郁症状与 PAD 患者全因死亡率增加 24%相关。未来的研究应探讨这种关联的机制和方向性，并将抑郁确定为 PAD 患者需要解决的重要合并症。
PROSPERO CRD42021223694。
