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Depression as a risk factor for adverse outcomes in coronary heart disease

Kenneth E Freedland* and Robert M Carney

Author affiliations

Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St Louis, Missouri 63108, USA

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Citation and License

BMC Medicine 2013, 11:131  doi:10.1186/1741-7015-11-131

Published: 15 May 2013



Depression is firmly established as an independent predictor of mortality and cardiac morbidity in patients with coronary heart disease (CHD). However, it has been difficult to determine whether it is a causal risk factor, and whether treatment of depression can improve cardiac outcomes. In addition, research on biobehavioral mechanisms has not yet produced a definitive causal model of the relationship between depression and cardiac outcomes.


Key challenges in this line of research concern the measurement of depression, the definition and relevance of certain subtypes of depression, the temporal relationship between depression and CHD, underlying biobehavioral mechanisms, and depression treatment efficacy.


This article examines some of the methodological challenges that will have to be overcome in order to determine whether depression should be regarded as a key target of secondary prevention in CHD.

Acute coronary syndrome; Antidepressive agents; Coronary disease; Depression; Depressive disorder; Mortality; Myocardial infarction; Psychotherapy