Depressed mood and flow-mediated dilation: a systematic review and meta-analysis

Abstract

Objective: This systematic and quantitative review evaluates the literature on associations between depressed mood and flow-mediated dilation (FMD), a measure of endothelial function, in adults.

Methods: Published English-language articles (through December 2010) were identified from literature searches, assessed for data extraction, and evaluated for quality.

Results: The literature includes cross-sectional (n = 9) and retrospective examinations (n = 3) of how FMD correlates with clinical or subclinical depression in healthy adults and cardiovascular patients (total N across 12 studies = 1491). FMD was assessed using a variety of methodologies. Samples were predominately older white and Asian subjects with higher socioeconomic status. In eight of the 12 articles selected for this review, at least one significant inverse association was noted between depressed mood and FMD, with primarily moderate effect sizes. The overall meta-analysis (random-effects model) revealed a combined effect size of correlation coefficient r = 0.19 (95% confidence interval = 0.08-0.29, p = .001). Significant combined effects were found for subgroups of studies that a) received better quality ratings (r = 0.29), b) examined patients with cardiovascular disease or with cardiovascular disease risk factors/comorbidity (r = 0.29), c) used maximum vasodilation to quantify FMD (r = 0.27), and d) assessed samples that had a mean age of 55 years and older (r = 0.15).

Conclusions: Diverse studies support the inverse correlation between depressed mood and endothelial function, as measured by FMD. This literature would be strengthened by prospective studies, increased methodological consistency in FMD testing, and broader sampling (e.g., African Americans, younger age, lower socioeconomic status).

Figure 1

Flow diagram of process used in selection of studies for review.

Figure 2

Percent change (or maximum percent change) in diameter and effect sizes of better-quality studies. Of these six studies, only Taylor et al. (28) showed a nonsignificant (ns) association between FMD and depression. max = maximum; %Δ = percent change.

Figure 3

Funnel plot of the overall effect estimates (r) by their standard errors to assess publication bias. The vertical line reflects the summary effect estimate, and the dashed lines show pseudo 95% confidence limits for the summary effect estimate.