Mechanisms linking depression to cardiovascular disease: What do epidemiological studies tell us?

Abstract

The burden of disease for depression goes beyond functioning and quality of life and extends to somatic health. Depression has shown to subsequently increase the risk of cardiovascular morbidity and mortality. These somatic consequences can be partly explained by mediating mechanisms such as unhealthy lifestyle (smoking, excessive alcohol use, physical inactivity, unhealthy diet) or unfavorable pathophysiological disturbances (metabolic, immuno-inflammatory, autonomic, and HPA-axis dysregulations). This chapter presents epidemiological evidence for the existence of these plausible underlying mechanisms that link depression to cardiovascular disease. However, alternative explanations for an increased cardiovascular risk in depressed persons are also discussed, namely, the confounding hypothesis, iatrogenic effects, or noncausal "third factors."