Resumen
El objetivo es investigar la asociación entre la depresión, la ansiedad y el desarrollo de enfermedades cardiovasculares (ECV). Se realizó una revisión sistemática con metaanálisis que incluyó estudios observacionales sin restricciones de fecha o idioma en las bases de datos PubMed, Embase, Scopus, Web of Science, PsycINFO y literatura gris, excluyendo cartas, editoriales, protocolos y resúmenes de congresos. Se aplicaron descriptores de DeCS, MeSH, Emtree y palabras clave relevantes. Tres revisores independientes realizaron análisis cualitativos y cuantitativos (odds ratio - OR y frecuencia) utilizando EndnoteWeb y el software Comprehensive Meta-Analysis (modelo de efectos aleatorios, pruebas I² y Q de Cochran). Las herramientas del Joanna Briggs Institute respaldaron la evaluación del riesgo de sesgo, y se utilizó el enfoque GRADE para evaluar la solidez de la evidencia. Se incluyeron catorce estudios publicados entre 2008 y 2024, con un total de 471.104 participantes de ambos sexos, con edades comprendidas entre 41,2 y 66,6 años, y con una calidad metodológica de moderada a alta. Los hallazgos revelaron un aumento del 85% en la probabilidad de que las personas con depresión desarrollen ECV (OR = 1,85; IC del 95%: 1,47-2,33; p < 0,001; I² = 27%) y un aumento del 18% en la probabilidad de que las personas con ansiedad (OR = 1,18; IC del 95%: 0,84-1,67; p > 0,05; I² = 86%). La depresión y la ansiedad son factores psicosociales importantes que contribuyen significativamente al riesgo de desarrollar o empeorar enfermedades cardiovasculares.
Citas
BOURKE, M. et al. The Effect of Interventions That Target Multiple Modifiable Health Behaviors on Symptoms of Anxiety and Depression in Young People: A Meta-Analysis of Randomized Controlled Trials. J Adolesc Health., v. 70, n. 2, p. 208-219, 2022. DOI: 10.1016/j.jadohealth.2021.08.005. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34580029/. Acesso em: 12 mar. 2025.
BOURKE, M. et al. Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: a systematic review and meta-analysis of observational studies. Clinical Psychology Review, v. 118, p. 102585, 2025. DOI: 10.1016/j.cpr.2025.102585. Disponível: https://pubmed.ncbi.nlm.nih.gov/40239241/. Acesso em: 05 set. 2025.
BREIK, W.; ELBEDOUR, S. The Predictive Ability of Type D Personality Pattern, Anxiety, and Depression in Cardiac Disease. European Journal of Mental Health, v. 16, n. 2, p. 196-209, 2021. Disponível em: https://ejmh.semmelweis.hu/index.php/ejmh/article/view/230. Acesso em: 14 set. 2025.
BUENO, H. et al. ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee: developed by the task force on mental health and cardiovascular disease of the European Society of Cardiology (ESC) Endorsed by the European Federation of Psychologists' Associations AISBL (EFPA), the European Psychiatric Association (EPA), and the International Society of Behavioral Medicine (ISBM). European Heart Journal, v. 46, n. 41, p. 4156- 4225, 2025. Disponível em: https://academic.oup.com/eurheartj/article/46/41/4156/8234498. Acesso em: 12 mar. 2025.
CARNEY, R. M.; FREEDLAND, K. E. Depression and cardiovascular disease: mechanisms of interaction. Biological Psychiatry, v. 54, p. 256-267, 2003.
CAO, H.; ZHAO, H.; SHEN, L. Depression and risk of coronary heart disease: a meta-analysis of prospective cohort studies. Front Cardiovasc Med., 9, 2022. DOI: https://doi.org/10.3389/fcvm.2022.913888. Disponível em: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.913888/full. Acesso em: 10 set. 2025.
CHEN, Q. et al. Association of Life's Essential 8 With Incident Cardiovascular Disease Among Individuals with Depression: a prospective study. Can J Cardiol., v. 40, n. 12, p. 2640-2648, 2024. DOI: 10.1016/j.cjca.2024.08.280. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39216657/. Acesso em: 11 ago. 2025.
EMDIN, C. A. et al. Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease. Am J. Cardiol., v. 118, n. 4, p. 511-519, 2016. DOI: 10.1016/j.amjcard.2016.05.041. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27324160/. Acesso em: 14 mar. 2025.
FRASURE-SMITH, N.; LESPÉRANCE, F. Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients with Stable Coronary Artery Disease. Archives of General Psychiatry, 65, n. 1, p. 62-71, 2008. Disponível em: https://pubmed.ncbi.nlm.nih.gov/18180430/. Acesso em: 13 set. 2025.
GRIPPO, A. J.; JOHNSON, A. K. Stress, depression and cardiovascular dysregulation: a review of neurobiological mechanisms and the integration of research from preclinical disease models. Stress, v. 12, n. 1, p. 1-21, 2009. DOI: 10.1080/10253890802046281. Disponível em: https://pubmed.ncbi.nlm.nih.gov/19116888/. Acesso em: 12 mar. 2025.
HOLT, R. I. G. et al. The relationship between depression, anxiety and cardiovascular disease: findings from the Hertfordshire Cohort Study. Journal of Affective Disorders, v. 150, n. 1, p. 84-90, 2013. Disponível em: https://www.sciencedirect.com/science/article/pii/S0165032713001869?via%3Dihub. Acesso em: 10 ago. 2025.
KINLEY, D. J. et al. Depression and anxiety disorders and the link to physician diagnosed cardiac disease and metabolic risk factors. General Hospital Psychiatry, v. 37, n. 4, p. 288-293, 2015. Disponível em: https://www.sciencedirect.com/science/article/pii/S0163834315000663?via%3Dihub. Acesso em: 12 mar. 2025.
KYROU, I. et al. Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study. European Journal of Preventive Cardiology, v. 24, n. 2, p. 145-152, 2017. Disponível em: https://academic.oup.com/eurjpc/article/24/2/145/5926614. Acesso em: 10 set. 2025.
KRITTANAWONG, C. et al. Association of depression with incident cardiovascular disease: a systematic review and meta-analysis. Am J Med., v. 136, n. 9, p. 881-895, 2023. DOI: 10.1016/j.amjmed.2023.04.036. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37247751/. Acesso em; 12 mar. 2025.
KOLLIA, N. et al. Exploring the path between depression, anxiety and 10-year cardiovascular disease incidence, among apparently healthy Greek middle-aged adults: The ATTICA study. Maturitas, v. 106, p. 73-79, 2017. Disponível em: https://www.sciencedirect.com/science/article/pii/S0378512217307442?via%3Dihub. Acesso em: 10 ago. 2025.
LEVINE, G. N. et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation, v. 43, n. 10, p. e763-e783, 2021. DOI: 10.1161/CIR.0000000000000947. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33486973/. Acesso em: 12 out. 2025.
LLOYD-JONES, D. M. et al. American Heart Association. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory from the American Heart Association. Circulation, v. 146, n. 5, p. e18-e43, 2022. DOI: 10.1161/CIR.0000000000001078. Disponível em: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001078. Acesso em: 12 mar. 2025.
MANOLIS, T. A.; MANOLIS, A. A.; MANOLIS, A. S. Emotional stress in cardiac and vascular diseases, Current Vascular Pharmacology, v. 23, n. 3, p. 172-195, 2025. 10.2174/1570161117666190425165958. DOI: 10.2174/0115701611328094241104062903. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39754763/. Acesso em: 10 sert. 2025.
NAKADA, S. et al. Individual and joint associations of anxiety disorder and depression with cardiovascular disease: a uk biobank prospective cohort study. European Psychiatry, v. 66, n. 1, p. e54, 2023. Disponível em: https://www.cambridge.org/core/journals/european-psychiatry/article/individual-and-joint-associations-of-anxiety-disorder-and-depression-with-cardiovascular-disease-a-uk-biobank-prospective-cohort-study/F11362D8F357FEEADFAC0BC0BE942559. Acesso em: 11 set. 2025.
PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, n. 71, 2021. Disponível em: https://www.prisma-statement.org. Acesso em: 10 out. 2025.
PELLETIER, R. et al. Relative associations between depression and anxiety on adverse cardiovascular events: does a history of coronary artery disease matter? A prospective observational study. BMJ Open, v. 5, n.12, p. e006582, 2015. Disponível em: https://bmjopen.bmj.com/content/5/12/e006582. Acesso em: 15 out. 2025.
PENNELLS, L.; MASCIE-TAYLOR, C. G. N. Depression and incident cardiovascular disease. JACC: Asia, v. 4, n. 4, 2024. Disponível em: https://www.jacc.org/doi/10.1016/j.jacasi.2024.02.003. Acesso em: 12 abr. 2025.
PETER, R. S. et al. Long‐term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events. Depression and Anxiety, v. 37, p. 784-792, 2020. Disponível em: https://onlinelibrary.wiley.com/doi/10.1002/da.23011. Acesso em: 22 mar. 2025.
RIAHI, S. M.; YOUSEFI, A.; SAEEDI, F.; MARTIN, S. S. Associations of emotional support, chronic stress, anxiety, and depressive symptoms with incidence of hard cardiovascular disease: the multi-ethnic study of atherosclerosis (MESA). BMC Cardiovascular Disorders, v. 23, n. 236, 2023. Disponível em: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-023-03195-x. Acesso em: 22 mar. 2025.
SARA, J. D. et al. Mental stress and its effects on vascular health. Mayo Clinic Proceedings, 97, n. 5, p. 1372-1389, 2022. DOI: 10.1016/j.mayocp.2022.02.004. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC9058928/. Acesso em: 12 out. 2025.
SELDENRIJK, A. et al. Depression, anxiety and 6-year risk of cardiovascular disease. Journal of Psychosomatic Research, 78 n. 2, p. 123-129, 2015. OI: https://doi.org/10.1016/j.jpsychores.2014.10.007. Disponível em: https://www.sciencedirect.com/science/article/pii/S0022399914003717?via%3Dihub. Acesso em: 12 set. 2025.
SHEN, Q. et al. Psychiatric disorders and subsequent risk of cardiovascular disease: a nationwide cohort and co-sibling study. EClinicalMedicine, v. 61, p. 102063, 2023. DOI: 10.1016/j.eclinm.2023.101926. Disponível em: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00240-7/fulltext. Acesso em: 10 ago. 2025.
SMITH, P. J.; BLUMENTHAL, J. A. Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment. Revista Española de Cardiología, v. 64, n. 10, p. 924-933, 2011. DOI: 10.1016/j.recesp.2011.06.003. Disponível em: https://pubmed.ncbi.nlm.nih.gov/21889253/. Acesso em:10 set. 2025.
STROUP, D. F. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA, v. 283, n. 15, p. 2008-2012, 2000. Disponível em: https://pubmed.ncbi.nlm.nih.gov/10789670/. Acesso em: 12 set. 2025.
VACCARINO, V. et al. Mental health disorders and their impact on cardiovascular health disparities. The Lancet Regional Health – Europe, v. 56, p. 101373, 2025. DOI: 10.1016/j.lanepe.2025.101373. Disponível em: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(25)00165-6/fulltext. Acesso em: 12 out. 2025.
VAN MOOK, W. N. K. A.; GASPARINI, A.; VAN VELDHUISEN, D. J.; SNEHOTA, P. Pathophysiological relationships between heart failure and depression and anxiety. Cardiovascular Drugs and Therapy, v. 28, p. 447-459, 2014.
VISSEREN, F. L. J. et al. ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J, v. 42, n. 34, p. 3227-3337, 2021. DOI:10.1093/eurheartj/ehab484. Disponível em: https://academic.oup.com/eurheartj/article/42/34/3227/6358713. Acesso em: 12 out. 2025.
VOGELZANGS, N. et al. Cardiovascular disease in persons with depressive and anxiety disorders. Journal of Affective Disorders, v. 125, n. 1-3, p. 241-248, 2010. Disponível em: https://www.sciencedirect.com/science/article/pii/S0165032710002144?via%3Dihub. Acesso em: 10 mar. 2025.
WANG, X. et al. Association of Depressive and Anxiety Symptoms with Risk of Cardiovascular Disease in Middle-Aged and Older Chinese Women, Asia Pacific. Journal of Public Health, v. 36, n. 2-3, p. 184-191, 2024. Disponível em: https://journals.sagepub.com/doi/10.1177/10105395241237664. Acesso em; 12 mar. 2025.
WHANG, W. et al. Relations between Depressive Symptoms, Anxiety, and T Wave Abnormalities in Subjects without Clinically-apparent Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA]). American Journal of Cardiology, 114, n. 12, p. 1917-1922, 2014. Disponível em: https://www.sciencedirect.com/science/article/pii/S0002914914018621?via%3Dihub. Acesso em: 12 out. 2025.
ZENG, J. et al. Cardiovascular disease and depression: a systematic review, meta-analysis and Mendelian randomization study. Mol Psychiatry, v. 30, p. 4234-4246, 2025. Disponível em: https://www.nature.com/articles/s41380-025-03003-2. Acesso em: 11 mar. 2025.

