Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis

Kristian Barlinn,1 Jessica Kepplinger,1 Volker Puetz,1 Ben M Illigens,2 Ulf Bodechtel,1 Timo Siepmann1 1Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany; 2Department of Neurology, Beth Israel Deaconess Medical Cent...

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Autores principales:	Barlinn K, Kepplinger J, Puetz V, Illigens BM, Bodechtel U, Siepmann T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/377ec7ac7917477fa867c328313e1aac
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spelling	oai:doaj.org-article:377ec7ac7917477fa867c328313e1aac2021-12-02T07:03:40ZExploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis1178-2021https://doaj.org/article/377ec7ac7917477fa867c328313e1aac2014-12-01T00:00:00Zhttp://www.dovepress.com/exploring-the-risk-factor-association-between-depression-and-incident--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021 Kristian Barlinn,1 Jessica Kepplinger,1 Volker Puetz,1 Ben M Illigens,2 Ulf Bodechtel,1 Timo Siepmann1 1Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany; 2Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Abstract: There is growing evidence that depression increases the risk of incident stroke. However, few studies have considered possible residual confounding effects by preexistent cerebrovascular and cardiac diseases. Therefore, we synthesized data from cohort studies to explore whether depressed individuals free of cerebrovascular and cardiac diseases are at higher risk of incident stroke. We searched the electronic databases PubMed and Medline for eligible cohort studies that examined the prospective association between depression and first-ever stroke. A random-effects model was used for quantitative data synthesis. Sensitivity analyses comprised cohort studies that considered a lag period with exclusion of incident strokes in the first years of follow-up to minimize residual confounding by preexistent silent strokes and excluded cardiac disease at baseline. Overall, we identified 28 cohort studies with 681,139 participants and 13,436 (1.97%) incident stroke cases. The pooled risk estimate revealed an increased risk of incident stroke for depression (relative risk 1.40, 95% confidence interval [CI] 1.27–1.53; P<0.0001). When we excluded incident strokes that occurred in the first years of follow-up, the prospective association between depression and incident stroke remained significant (relative risk 1.64, 95% CI 1.27–2.11; P<0.0001). This positive association also remained after we considered only studies with individuals with cardiac disease at baseline excluded (relative risk 1.43, 95% CI 1.19–1.72; P<0.0001). The prospective association of depression and increased risk of first-ever stroke demonstrated in this meta-analysis appears to be driven neither by preexistence of clinically apparent cerebrovascular and cardiovascular diseases nor by silent stroke. Keywords: stroke, prestroke, depression, risk factorBarlinn KKepplinger JPuetz VIlligens BMBodechtel USiepmann TDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2015, Iss default, Pp 1-14 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Barlinn K Kepplinger J Puetz V Illigens BM Bodechtel U Siepmann T Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
description	Kristian Barlinn,1 Jessica Kepplinger,1 Volker Puetz,1 Ben M Illigens,2 Ulf Bodechtel,1 Timo Siepmann1 1Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany; 2Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Abstract: There is growing evidence that depression increases the risk of incident stroke. However, few studies have considered possible residual confounding effects by preexistent cerebrovascular and cardiac diseases. Therefore, we synthesized data from cohort studies to explore whether depressed individuals free of cerebrovascular and cardiac diseases are at higher risk of incident stroke. We searched the electronic databases PubMed and Medline for eligible cohort studies that examined the prospective association between depression and first-ever stroke. A random-effects model was used for quantitative data synthesis. Sensitivity analyses comprised cohort studies that considered a lag period with exclusion of incident strokes in the first years of follow-up to minimize residual confounding by preexistent silent strokes and excluded cardiac disease at baseline. Overall, we identified 28 cohort studies with 681,139 participants and 13,436 (1.97%) incident stroke cases. The pooled risk estimate revealed an increased risk of incident stroke for depression (relative risk 1.40, 95% confidence interval [CI] 1.27–1.53; P<0.0001). When we excluded incident strokes that occurred in the first years of follow-up, the prospective association between depression and incident stroke remained significant (relative risk 1.64, 95% CI 1.27–2.11; P<0.0001). This positive association also remained after we considered only studies with individuals with cardiac disease at baseline excluded (relative risk 1.43, 95% CI 1.19–1.72; P<0.0001). The prospective association of depression and increased risk of first-ever stroke demonstrated in this meta-analysis appears to be driven neither by preexistence of clinically apparent cerebrovascular and cardiovascular diseases nor by silent stroke. Keywords: stroke, prestroke, depression, risk factor
format	article
author	Barlinn K Kepplinger J Puetz V Illigens BM Bodechtel U Siepmann T
author_facet	Barlinn K Kepplinger J Puetz V Illigens BM Bodechtel U Siepmann T
author_sort	Barlinn K
title	Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
title_short	Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
title_full	Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
title_fullStr	Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
title_full_unstemmed	Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
title_sort	exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/377ec7ac7917477fa867c328313e1aac
work_keys_str_mv	AT barlinnk exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis AT kepplingerj exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis AT puetzv exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis AT illigensbm exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis AT bodechtelu exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis AT siepmannt exploringtheriskfactorassociationbetweendepressionandincidentstrokeasystematicreviewandmetaanalysis
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Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis

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