Myocardial infarction and depression may influence each other over time, but evidence on their bidirectional relationship has remained limited. A systematic review and meta-analysis published in the European Journal of Preventive Cardiology evaluated longitudinal associations between myocardial infarction (MI) and depression, along with shared comorbidities and cardiovascular risk factors.
The analysis included prospective cohort and longitudinal studies identified through PubMed, Embase, and PsycINFO from inception to 31 December 2025. Adjusted hazard ratios (HRs) were pooled using random-effects models, heterogeneity was assessed using the I² statistic, and study quality was evaluated with the Newcastle-Ottawa Scale. Subgroup analyses by age and sex and sensitivity analyses restricted to high-quality studies and clinically diagnosed depression were performed.
Nine population-based cohort studies were included. Meta-analysis of two studies showed that MI was associated with an increased risk of subsequent depression (pooled HR 1.41; 95% CI 1.24-1.61; I²=0%). In the opposite direction, eight studies evaluating depression as the exposure showed an increased risk of incident MI (pooled HR 1.42; 95% CI 1.29-1.57), with substantial heterogeneity (I²=84.7%).
Stratified estimates from individual studies suggested stronger relative associations among younger individuals and sex-specific differences in the direction of the association. Limited evidence indicated that tricyclic antidepressant use was associated with higher observed MI risk, whereas selective serotonin reuptake inhibitors were not. Shared comorbidities included diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, anxiety, post-traumatic stress disorder, and chronic kidney disease.
These findings show that MI and depression are associated with increased risk of each other and commonly co-occur with cardiometabolic and mental comorbidities. However, interpretation is limited by the small number of studies and heterogeneity across analyses.
