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The role of depression in the primary prevention of cardiovascular disease

To the Editor: We would like to add a cautionary note to O’Neil’s support for the inclusion of “depression and other psychosocial factors” in the updated National Vascular Disease Prevention
Alliance guidelines for assessing cardiovascular disease (CVD) risk. Her statement “it is now clear that depression is also an important risk factor for CVD” is premature.1 Different authors have challenged the suggested relationship and, given divergent findings and opinions, it is misleading to claim that the matter is now “clear”.25 We do not deny a possible link between depression and coronary heart disease (CHD) but suggest that the extent and nature of the relationship has yet to be clarified. Premature acceptance and promotion of the idea that depression is a risk factor for CHD might contribute to overdiagnosis and overtreatment of depression as well as undue worry about the risk of CHD by individuals diagnosed with depression.