A systematic review and meta-analysis
J Psychiatr Res 2021 141:152-159 Endothelial dysfunction in people with depressive disorders: A systematic review and meta-analysis Aline J Waclawovsky 1, Edineia de Brito 2, Lee Smith 3, Davy Vancampfort 4, Antônio M V da Silva 5, Felipe B Schuch 6 Abstract The study aimed to identify whether people diagnosed with depression have endothelial dysfunction, assessed by the technique of flow-mediated dilation (FMD), when compared to controls without depression. In addition, to verify whether people with depressive symptoms have impaired endothelial function when compared to controls without symptoms. Also to explore the potential moderators of the association between depression and endothelial dysfunction. Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase and Web of Science, from inception to April 16, 2021, for studies in people with depression and controls evaluating endothelial function through FMD. The primary outcome was the percentage of change in FMD. Comparative random effects meta-analysis, calculating the mean difference (MD) of the FMD between depressed and controls was performed. Potential sources of heterogeneity were explored by meta-regressions and subgroup analyses. The study protocol was registered with PROSPERO (CRD42020192070). Nine studies evaluating 1367 participants (379 depressed and 988 controls) (median age = 39.8 years, 44.9% men) were included. People with depression had lower FMD = -1.48% (95%CI = -2.62 to -0.33). High density lipoprotein (HDL) cholesterol levels moderated the effect (beta = -0.408, 95%CI = -0.776 to -0.040). Differences in FMD were found when assessment was done in the first minute after release of the occlusion, when using occlusion position in distal forearm, and when using occlusion pressure between 250 and 300 mmHg. Those with clinical depression (established by diagnostic instruments) presented the greatest [endothelial] dysfunction. Individuals with depression have a more impaired endothelial dysfunction when compared to controls. HDL cholesterol levels and differences in FMD assessment modalities moderate the difference. Keywords: Depression; Endothelial dysfunction; Endothelium; Major depressive disorder. Copyright © 2021 Elsevier Ltd. All rights reserved.
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