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stroke is a major cause of disability and mortality
depression has a high incidence of 5.7% among men and 9.5% among women during 12 months
depression has been linked to diabetes and hypertension

THE NEW META-ANALYSIS
based on meta-analysis of 28 studies and systematic review of prospective cohort studies
most studies from US or Europe, 3 Japanese, 1 Australia, 1 Taiwan, 1 international
moderate to high heterogeneity was seen across the studies
n = 317,540 adults over 18 yoa
strokes = 8478 mostly assessed by death certificates and medical records
follow-up period 2-29 years
depression defined as both self-reported or clinician diagnosis
meta-analysis results in 9/21/11 JAMA. 2011;306:1241-1249.
http://jama.ama-assn.org/content/306/11/1241.abstract

FINDINGS
significantly increased risk for stroke and stroke-related mortality among those with depression
depression assoc w 45% incr risk for total stroke
55% incr risk for fatal stroke
25% incr risk for ischemic stroke
not associated with an incr risk for hemorrhagic stroke

est 3.9% (n = 273,000) of strokes could be attributed to depression
incr risk was more evident among studies with short follow-up, younger participants, and Asians
association was weaker for smokers vs nonsmokers
BMI also affects the association

DEPRESSION
highly prevalent
5.8% of men and 9.5% of women will experience a depressive episode in a 12-month period
lifetime incidence of depression estimated at 16%+
higher in people with comorbidities such as obesity, diabetes, and hypertension
depression-->incr risk of obesity, diabetes, and coronary heart disease
in US risk est 9.0% currently depressed (21 million people)

"Depression should be considered as an independent risk factor for the future risk of stroke."
--lead investigator An Pan, PhD, from the Harvard School of Public Health in Boston

self reported depression scales used: Center for Epidemiologic Studies Depression Scale, Geriatric Depression Scale, Zung Self-Rating Depression Scale, Beck Depression Inventory

THEORIZED MECHANISMS BY WHICH DEP-->STROKE
neuroendocrine
immunological
inflammatory
negative health behaviors: smoking, poor diet, and physical inactivity

PREVIOUS STUDIES
previous meta-analysis of 10 studies relating dep to CV outcomes found stroke risk
more prospective cohort studies have been published

ABSOLUTE RISK OF STROKE BY TYPE, PER YEAR, FOR DEPRESSED INDIVIDUALS
Stroke Absolute Risk (Cases)
Total 106
Ischemic 53
Fatal 22

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