Impact of comorbid depression on clinical outcomes in patients with peripheral artery disease: a systematic review and meta-analysis
- Journal
- Frontiers in cardiovascular medicine (Q1)
- Published
- 21 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Chuwen Chen, Lijia Wei, Jing Hu, Huanrui Hu, Bin Huang, Jichun Zhao, et al.
- PMID
- 42699239
- DOI
- 10.3389/fcvm.2026.1854607
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 11 September 2026): Depression associated with higher major amputation and MACE risk
Abstract
BACKGROUND: Depression is a common comorbidity in cardiovascular disease; however, its prognostic impact in peripheral artery disease (PAD) remains uncertain. This study evaluated the association between depression and clinical outcomes in patients with PAD. METHODS: PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to December 2025. Observational studies comparing PAD patients with and without depression were included. Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), major amputation, and major adverse limb events (MALE). Random-effects meta-analyses were performed. RESULTS: Thirteen studies involving 681,959 patients were included. Compared with those without depression, PAD patients with depression were generally younger and had a higher burden of cardiovascular and metabolic comorbidities. Depression was not significantly associated with all-cause mortality in pooled analyses of either odds ratios (OR = 2.01; 95% CI: 0.77-5.27; p = 0.15) or hazard ratios (HR = 1.15; 95% CI: 0.97-1.36; p = 0.11). However, depression was significantly associated with worse limb-related outcomes, including major amputation (OR = 1.25; 95% CI: 1.15-1.37; p < 0.001, HR = 1.36; 95% CI: 1.21-1.54; p < 0.001) and MALE (OR = 1.24, 95% CI: 1.16-1.33, p < 0.001). Depression was also associated with a higher risk of MACE in both pooled OR analysis (OR = 1.82; 95% CI: 1.02-3.26; p = 0.04) and time-to-event analysis (HR = 1.24; 95% CI: 1.15-1.35; p < 0.001). CONCLUSIONS: In PAD, comorbid depression was associated with higher MALE and MACE risks, but not all-cause mortality. These findings suggest that mental health assessment may be considered as part of comprehensive PAD care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.