The role of depression in the primary prevention of cardiovascular disease

In reply: I thank Stampfer, Hince and Dimmitt for their response. While I acknowledge that there are aspects of the relationship between cardiovascular disease (CVD) and depression that remain undetermined, recent evidence clearly supports the role of depression as an independent risk factor for CVD and is indeed convincing.1-3 This is especially true in studies that assess depression using diagnostic criteria.4 We know that the risk of developing coronary heart disease (CHD) for individuals with depression is twofold, and these individuals have a similar risk of CVD-related death.2 We also know that the independent contribution of depression to CVD is at least comparable to that of more traditional risk factors including diabetes, hypercholesterolaemia, smoking or obesity.5 A decade has now passed since the National Heart Foundation’s seminal position paper concluded that: “there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD”.5 Despite this, depression remains underestimated as a meaningful contributor to CVD.