Comparison of Clinical Efficacy of Ticagrelor and Clopidogrel for Treatment of Coronary Heart Disease with Myocardial Ischemia

Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coronary heart disease patients with myocardial ischemia admitted to our hospital from July 20 to July 2019 were recruited as subjects.They were randomly divided into study group and control group according to parity of case number,with 48 patients in each group.Control group was given treatment with clopidogrel,while patients in study group were given treatment with ticagrelor.Clinical efficacy was compared between the both groups.Results.Comparison showed that total effective rate of clinical treatment was higher in study group when compared to control group(P<0.05).Frequency of ST segment depression,duration of ST segment depression,systolic blood pressure,diastolic blood pressure,heart rate and other clinical indicators in study group were superior to control group(P<0.05).Whole blood viscosity at low shear rate,whole blood viscosity at high shear rate,plasma viscosity shear rate,total cholesterol,triglyceride and other haemorheological parameters in study group were superior to control group(P<0.05).Conclusion.Application of ticagrelor has higher clinical efficacy than clopidogreal for coronary heart disease patients with myocardial ischemia.Clinical indicators and haemorheological parameters of myocardial ischemia patients were significantly improved.It should be promoted for application.

Effects of Aerobic Exercise Combined with Resistance Training on Patients with Myocardial Ischemia Caused by Coronary Heart Disease

Objective:To explore the clinical effect of long-term aerobic exercise combined with resistance training in patients with myocardial ischemia caused by coronary heart disease and its influence on cardiac function, exercise endurance and quality of life. Methods:100 patients with myocardial ischemia caused by coronary heart disease from January 2017 to January 2019 were randomly divided into control group (n = 50 cases) and observation group (n = 50 cases). The control group was given resistance training, while the observation group was combined with long-term aerobic exercise on the basis of the control group. The two groups were treated for 3 months. The cardiac function, exercise endurance and quality of life were compared between the two groups. Results:The levels of IVST (8.20+1.32) mm, LVDD (46.43+4.13) mm and LVSD (32.59+3.15) mm in the observation group were lower than those in the control group at 3 months after treatment. The level of LVEF (67.49+5.77)% in the observation group was higher than that in the control group at 3 months after treatment. The difference between the two groups was significant (P<0.05). The ET (55.42+2.9) in the observation group was higher than that in the control group (P<0.05). 2) The levels of ng/L and TXB2 (93.23 + 6.26) ng/L were significantly lower than those of the control group, and the difference between the two groups was statistically significant (P<0.05). The 6-minute walking distance (561.25 +43.64) m and the quality of life score (95.31 +6.39) in the observation group were higher than those in the control group 3 months after treatment, and the difference between the two groups was statistically significant (P<0.05). Conclusions:Long-term aerobic exercise combined with resistance training can improve cardiac function, exercise tolerance and quality of life in patients with myocardial ischemia caused by coronary heart disease, which is worthy of popularization and application.

A Clinical Investigation on Tong Xin Luo Capsule in Treatment of Coronary Heart Disease with Silent Myocardial Ischemia

有沉默心肌的局部缺血(SMI ) 的冠的心脏病的 36 个盒子在随机的顺序与 Tong 罗欣(TXL ) 囊和 isosorbide 二硝酸盐顺序被对待。结果证明药在 SMI 的减少的事件是有效的并且弄短无征状的心肌的局部缺血的持续时间。然而， TXL 随一个更好的行动被发现并且比 isosorbide 二硝酸盐优异。TXL 能也改进左室的心脏舒张的功能，这也被发现。

Myocardial bridge-related coronary heart disease:Independent influencing factors and their predicting value

BACKGROUND Myocardial bridge(MB)will compress the mural coronary artery(MCA)during the systole and cause myocardial ischemia.In the diagnosis of coronary heart disease(CHD),because the structure of MB is difficult to be observed by coronary angiography(CAG),the clinical study of the influence of MB on CHD is lacking.With the advancement of computed tomography coronary angiography technology,detailed observations of the MB anatomy have realized.AIM To explore the main influencing factors of MB-related CHD and to find potential indicators for predicting MB-related CHD.METHODS A total of 1718 patients with suspected CHD due to the symptoms of myocardial ischemia were enrolled as subjects.Patients diagnosed with CHD were included in a CHD group,and patients with no significant abnormalities were included in a control group.In the CHD group,patients were divided into an MB-CHD subgroup if MB-related CHD was found.In the control group,patients were divided into a simple MB subgroup if MB was found.The patient's clinical data and MB-related indicators,including the branch of MB,MB type(superficial/deep type),MB length,MB thickness,systolic and diastolic compression of the MCA,and MCA systolic stenosis rate were recorded and compared.Logistic regression analysis was used to explore the independent influencing factors of MD-related CHD.ROC curve was used to analyze the diagnostic efficacy of potential indicators for MB-related CHD.RESULTS There were 1060 cases in the CHD group and 658 cases in the control group,and there were 236 cases in the MB-CHD subgroup and 52 cases in the simple MB subgroup.Multivariate logistic regression analysis showed that the combined MB had a significant effect on the occurrence of CHD(P<0.05).MB thickness,systolic compression,diastolic compression,and MCA systolic stenosis rate had significant effects on the occurrence of MB-related CHD(P<0.05).The area under the curve(AUC)of the combination of these influencing factors for the diagnosis of MB-related CHD was 0.959,which was significantly higher than the AUCs of the four indicators separately(P<0.05).The sensitivity was 97.06%and the specificity was 87.63%.CONCLUSION MB thickness,systolic compression,diastolic compression,and MCA systolic stenosis are independent influencing factors for MB-related CHD.The combination of these factors has potential diagnostic value for MB-related CHD.

Effect of Trimetazidine Dihydrochloride Tablets adjuvant therapy on inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function in patients with coronary heart disease complicated with heart failure

Objective: To investigate the effects of Trimetazidine Dihydrochloride Tablets on inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function in patients with coronary heart disease complicated with heart failure. Methods: A total of 98 patients with coronary heart disease and heart failure who met the criteria of the study were selected as the subjects, based on the random data table they were divided into the control group (n=49) and observation group (n=49), the patients in the control group were treated with Metoprolol Tartrate Sustained-release Tablets treatment, and the patients in the observation group were treated with Metoprolol Tartrate Sustained-release Tablets combined with Trimetazidine Dihydrochloride Tablets, the levels of inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function indexes were compared between the two groups before and after treatment. Results: The difference of the CRP, TNF-α, MDA, SOD, NO, ET-1, LVEF, LVEDD and LVESD levels in the two groups before treatment were not statistically significant;Compared with the levels of the two groups before treatment, the two groups of CRP, TNF-α, MDA, ET-1, LVEDD and LVESD levels after treatment were significantly decreased, and the level of the observation group after treatment was significantly lower than those levels in the control group, the difference was statistically significant;The levels of SOD, NO and LVEF of the two groups after treatment were significantly higher than those in the same group before treatment, and the observation group levels [(88.09±7.51) U/ml, (72.58±14.64) mol/L, (48.34±5.09)% ] were significantly higher than the control group [(79.44±7.27) U/ml, (61.89±11.06) mol/L, (44.19±4.58)%], the difference was statistically significant. Conclusion: Trimetazidine Dihydrochloride Tablets in the treatment of coronary heart disease with heart failure can effectively inhibit the release of inflammatory factors, improve oxidative stress state, vascular endothelial function and myocardial function, has an important clinical value.

Genotype frequency of gelatinase B C-1562 T polymorphism in coronary heart disease and myocardial infarction

Background One of the characteristics of atherosclerosis is a change in the content of extracellular matrix in the arterial wall. Gelatinase B, a member of the family of matrix metalloproteinase, can regulate extracellular matrix metabolismand play a role in the pathogenesis of atherosclerosis, coronary heart disease (CHD) and myocardial infarction (MI). Gelatinase B is polymorphic due to a C to T change at the position -1562 bp in the promoter region.Its relationship with gene product concentration in serum and its role in mediating the risk of CHD and MI in Germans is still unknown. Methods We enrolled 102 controls and 322 patients with angiographically documented CHD,including a sub-group of 173 patients with acute or chronic MI and 80 patients with acute coronary syndrome (ACS).All patients and controls were Germans and genotyped by polymerase chain reaction and digestion with SphI. Results We found that several classical risk factors for CHD and MI, including hypercholesterolemia and cigarette smoking,were significantly increased in CHD and MI patients compared with controls. Serum levels of gelatinase B and tissue inhibitor of metalloproteinase-1 were increased in the peripheral blood of patients with acute coronary syndrome. No significant differences in genotype or allelic frequencies between CHD, MI and control subjects of either men or women were found. Our search for a possible association of the polymorphisms with CHD and MI by logistic regression analysis was also negative. The serum concentrations of gelatinase B showed no differences between genotypes. Conclusions Our data showed that gelatinase B might provide an index of plaque activity in ACS, but gelatinase B protein was not affected by genotypes. Also, the T variant of gelatinase B was not associated with CHD or MI in Germans. (J Geriatr Cardiol 2004;1(2):114-118.)

Value of serum Fractalkine and Vaspin contents for the diagnosis of coronary heart disease and the correlation with cardiac function and myocardial injury

Objective: To study the value of serum Fractalkine and Vaspin contents for the diagnosis of coronary heart disease and the correlation with cardiac function and myocardial injury. Methods: A total of 80 patients with coronary heart disease were divided into stable angina pectoris group (n=45) and unstable angina pectoris group (n=35) according to the clinical seizure characteristics and signs. 50 subjects with normal cardiac function who received physical examination in the hospital over the same period were selected as the normal control group. The serum Fractalkine and Vaspin contents, cardiac function parameter levels under ultrasonic cardiogram and serum myocardial enzyme spectrum contents of each group were detected. Pearson test was used to further assess the inner link of serum Fractalkine and Vaspin contents with disease severity in patients with coronary heart disease. Results: Serum Fractalkine contents of stable angina pectoris group and unstable angina pectoris group were higher than that of normal control group while Vaspin contents were lower than that of normal control group, and serum Fractalkine content increased while Vaspin content decreased with the aggravation of angina pectoris. Cardiac function parameters LVEDD, LVEDV, LVESD and LVESV levels of stable angina pectoris group and unstable angina pectoris group were higher than those of normal control group, serum myocardial enzyme spectrum indexes CK, CK-MB, LDH, AST and ALT contents were higher than those of normal control group, and the levels of above indexes increased with the aggravation of angina pectoris. Serum Fractalkine content in patients with coronary heart disease was positively correlated with the decrease of cardiac function and the degree of myocardial injury while Vaspin content was negatively correlated with the decrease of cardiac function and the degree of myocardial injury. Conclusion: Serum Fractalkine and Vaspin contents are abnormal in patients with coronary heart disease, and the abnormal degree is directly related to the cardiac function and myocardial injury.

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUND Coronary heart disease(CHD)is a type of coronary atherosclerotic heart disease.In recent years,the incidence of CHD has been increasing annually,with an increasing number of young patients.Severe CHD may cause severe myocardial ischemia or myocardial necrosis,which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIM To examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODS From February 2019 to January 2020,110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age:middle-aged group(n=55)and young group(n=55).The coronary arteries and clinical features of the patients were compared.RESULTS There were no significant differences in dyslipidemia,stroke history,high-density lipoprotein cholesterol,or triacylglycerol(P>0.05)between the two groups.In the young group,age,diabetes,hypertension,smoking history,body mass index,family history of CHD,drinking history,fibrinogen,low-density lipoprotein cholesterol,total cholesterol,and single-vessel disease were higher than those in the middle-aged group.Correspondingly,serum uric acid,hyperuricemia,myocardial infarction,Gensini score>50,collateral circulation,multivessel disease,double vessel disease,involvement of the right coronary artery,and involvement of the left main coronary artery were lower in the young group than in the middle-aged group.The middle-aged group mainly suffered from a high Gensini score,implicating multiple arteries,whereas the young group was mainly affected by single-vessel disease.The between-group difference was significant(P<0.05).CONCLUSION In CHD attacks,multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.

The Effect of Sleep Deprivation on Coronary Heart Disease

Sleep deprivation(SD) has been associated with an increased morbidity and mortality of coronary heart disease(CHD). SD could induce autonomic nervous dysfunction, hypertension, arrhythmia, hormonal dysregulation, oxidative stress, endothelial dysfunction, inflammation and metabolic disorder in CHD patients. This paper reviewed the study results of SD in clinical trials and animal experiments and concluded that SD was associated with cardiovascular risk factors, which aggravated CHD in pathogenesis and outcomes.

Quantitative assessment of myocardial blush grade in patients with coronary artery disease and in cardiac transplant recipients

Quantitative assessment of myocardial perfusion by myocardial blush grade(MBG) is an angiographic computer-assisted method to assess myocardial tissue-level reperfusion in patients with acute coronary syndromes and microvascular integrity in heart transplant recipients with suspected cardiac allograft vasculopathy. This review describes the ability of quantitative MBG as a simple, fast and cost effective modality for the prompt diagnosis of impaired microvascular integrity during routine cardiac catheterization. Herein, we summarize the existing evidence, its usefulness in the clinical routine, and compare this method to other techniques which can be used for the assessment of myocardial perfusion.

Risk Assessment and Risk Perception of Coronary Heart Disease in Gaza Strip, Palastine

Aim: The aim of the present study was to estimate the prevalence of coronary heart diseases (CHD) risk factors among Ghaza (Palastine) university students, to assess the CHD risk among them using a suitable scoring system and to identify how they perceive their risk of CHD. Methods: During the period from May 2008 to May 2009, 501 students were involved. Participants were subjected to the following activities;self administered questionnaire: including socio-demographic data, medical history of chronic diseases, family history about CHD, knowledge and perception of risk factors, anthropometric measurements in addition to laboratory testing. Results: The mean age was 20.8 ± 2.07 years;54% were females. The prevalence of hypertension and DM was 3.6% and 0.4% while it was 2.6% for hypercholesterolemia. The mean levels of LDL-C (88 mg/dl vs 85.5 mg/dl) and HDL-C (52.4 mg/dl vs 42.6 mg/dl) were higher among females than among males. Smoking was more prevalent among males than among females (33.1% vs 1.7%) with a total prevalence of 19%. Overweight and obesity were more prevalent among males (30.7% vs 22.5% and 9.6% vs 5.6%). In contrast to risk perception female students tend to be more knowledgeable than males with regards to different aspects of CHD. The overall level of perceived risk was moderate. Logistic regression analysis revealed that age and sex were associated significantly by higher level of total perception (p < 0.05). Conclusion: Health education and health promotion programs should be implemented and integrated within the primary health care sectors and directed to university students before admission. Further research needed to be implemented on larger sample to test knowledge and perception of the public in regard to their risk for heart disease including school children and community so that education could be provided in a more focused manner.

Grid Search for Predicting Coronary Heart Disease by Tuning Hyper-Parameters

Diagnosing the cardiovascular disease is one of the biggest medical difficulties in recent years.Coronary cardiovascular(CHD)is a kind of heart and blood vascular disease.Predicting this sort of cardiac illness leads to more precise decisions for cardiac disorders.Implementing Grid Search Optimization(GSO)machine training models is therefore a useful way to forecast the sickness as soon as possible.The state-of-the-art work is the tuning of the hyperparameter together with the selection of the feature by utilizing the model search to minimize the false-negative rate.Three models with a cross-validation approach do the required task.Feature Selection based on the use of statistical and correlation matrices for multivariate analysis.For Random Search and Grid Search models,extensive comparison findings are produced utilizing retrieval,F1 score,and precision measurements.The models are evaluated using the metrics and kappa statistics that illustrate the three models’comparability.The study effort focuses on optimizing function selection,tweaking hyperparameters to improve model accuracy and the prediction of heart disease by examining Framingham datasets using random forestry classification.Tuning the hyperparameter in the model of grid search thus decreases the erroneous rate achieves global optimization.

Lipid Profile of Coronary Heart Disease Patients: A Prospective Observational Study

Background: Coronary heart disease (CHD) remains the major cause of mortality and morbidity in the entire world population despite therapeutic advances that control many risk factors. Lipid profile is regarded as an important factor in the development of coronary heart disease. There have been numerous studies confirming the association of hyperlipidemias with coronary heart disease in most of the Western as well as Asian countries of the world. But we have very little data on the relation between CHD and lipid profile. Aim of the Study: The aim of this study was to assess abnormal lipid levels and their association with coronary heart disease. Methods: This comparative observational study was conducted at the Department of Cardiology in M. Abdur Rahim Medical College, Dinajpur, Bangladesh from January 2019 to December 2019. Properly written consent was taken from all the participants before starting the main part of the investigation. Obeying inclusion and exclusion criteria of the study, a total of 131 participants were finalized as the study population. Among them, the Case Group was formed with 90 patients who had CHD, and with 41 healthy people, the Control Group was formed. All necessary data were collected, analyzed, and disseminated by several programs of MS-Office and SPSS version 23. Result: The study was conducted with 90 case group participants and 41 control group participants. Among the case group, 78% were male and 22% were female. Among the male case group participants, 44.29% were from 51 - 60 years of age, 35.71% were from 41 - 50 years of age and the rest 20% were above 60 years of age. On the other hand, among the female participants of Case Group, 45% were from 51 - 60 years of age, 30% from 41 - 50 years of age, and 25% were over 60 years of age. Regression analysis between the male and the female showed the P-value of 0.242. Serum cholesterol concentration and HDL concentration were significant between the Case and Control groups in all age groups and the P-value was <0.0001 in every age group. Triglyceride concentration was significant between the Case and Control groups in 41 - 50 and 51 - 60 years age groups with a P-value of <0.0001. But in the >60 years age group, we did not find any significant correlation and there the P-value was 0.478. LDL concentration between the groups showed significant correlations between the Case and Control groups in 41 - 50 and 51 - 60-years’ age groups where the P values were found, <0.0001 and 0.0002 respectively. But in the >60 years’ age group, we did not find any significant correlation and there the P- value was 0.515. Conclusion: In this study, it was found that the total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol concentrations were significantly higher in coronary heart disease (CHD) patients.

Pulse Wave Analysis in Patients with Coronary Heart Disease Based on Hilbert-Huang Transformation and Time-domain

Objective: To study the characteristics of pulse tracings in CHD, and objectively evaluate the significance of pulse signal in diagnosis and appreciation of therapeutic effect in patients with coronary heart disease(CHD), and accordingly provide with theoretic proofs for developing non-invasive technique of pulse diagnosis. Methods: By using the pulse detection system, pulse graphs in CHD patients, patients without CHD and "health" adults were collected and compared. Then characters of the pulse signal were analyzed with Hilbert-Huang transformation routine (HHT) and time-domain method respectively. Results: There existed characteristic change in pulse graph in CHD. ① h1,h3,h4,h3/h1,t,t5/t4 in time domain parameters of pulse graph increased and w1 was widened. ② 44% of C2 wave in HHT display showed chaotic and disorderly wave and irregularly wave amplitude in CHD. And 72% of C5 Wave exhibited in irregular wave with average wave amplitude over 10 gram-forces. These changes were significantly different from health adults. Conclusion: Characteristic wave of pulse graph extracted with methods of time domain or HHT routine might be considered as proofs for diagnosis and differentiation in CHD. Our researches prognosticate that pulse diagnosis can be used as an ancillary determination in occurrence of CHD for reasons of the advantage of convenient operation and non-invasion.

Coronary heart disease-related fatigue:risk factors,assessment and treatments

Coronary atherosclerotic heart disease is a disease of myocardial ischemia and hypoxia,which often presents as chest pain,dyspnea,cold sweat and fatigue.Fatigue is the subjective experience of patients,which is easy to be ignored,and will lead to the decline of patients’quality of life and physical activity level,etc.,with a high incidence and great harm.The purpose of this paper was to review the concept,risk factors,assessment tools and intervention measures of coronary atherosclerotic heart disease fatigue in order to provide a reference for identifying and improving the fatigue of coronary atherosclerotic heart disease.

Effect of Psychological Education Combined with Progressive Muscle Relaxation Training on the Symptom Cluster and Rehospitalization Rate of Elderly Patients with Coronary Heart Disease

Objective:To investigate the effect of psychological education combined with progressive muscle relaxation training on the symptom cluster and rehospitalization of elderly patients with coronary heart disease.Methods:This study is a longitudinal randomized controlled study involving 140 elderly patients with coronary heart disease.The patients were divided into two groups:an intervention group and a control group,with 70 cases in each group,via random number table.The patients in the control group received routine nursing,whereas those in the intervention group received psychological education combined with progressive muscle relaxation training for 4 weeks on the basis of routine nursing.The effect of the intervention was evaluated before intervention,at the end of 1 month,3 months,and 6 months after intervention.Results:At the end of 1 month,3 months,and 6 months,the sleep,fatigue,anxiety,and functional status of the patients in the intervention group were significantly better than those of the control group,with statistical significance difference(P<0.05).The rehospitalization rate of the intervention group was lower than that of the control group,and the difference was statistically significant(X2=10.685,P=0.001).Conclusion:Psychological education combined with progressive muscle relaxation training is effective in alleviating the symptom cluster of elderly patients with coronary heart disease and reducing their rehospitalization rate;thus,it should be popularized.

Efficacy of Danlou Tablet in the Treatment of Coronary Heart Disease with Phlegm and Blood Stasis Syndrome and Its Effects on Serum Inflammatory Factors

[Objectives] To explore the efficacy of Danlou Tablet( DLT) in the treatment of coronary heart disease( CHD) with phlegm and blood stasis syndrome and its effects on serum inflammatory factors. [Methods]One hundred and ninety-seven patients with CHD and phlegm and blood stasis syndrome in our hospital from January 2016 to January 2018 were selected and randomly divided into two groups: control group( n =98) treated with aspirin plus atorvastatin,and research group( n =99) treated with DLT and aspirin plus atorvastatin for one month. The clinical efficacy and incidence of adverse reactions were observed. Serum secretory phospholipase A2( s PLA2),lipoprotein-associated phospholipase A2( LP-PLA2),oxidized low-density lipoprotein( ox-LDL),monocyte chemoattractant protein-1( MCP-1) and World Health Organization Quality of Life( WHOQOL-100) scores were compared before and after one month of treatment. [Results] The total effective rate was93. 94% in the research group,which was higher than that in the control group( 79. 59%,P < 0. 05);the levels of serum s PLA2,LP-PLA2,ox-LDL and MCP-1 in the research group were lower than those in the control group after one month of treatment( P < 0. 05). There was no statistical significance of the difference in the total incidence of adverse reactions between the research group and the control group( P > 0. 05).After one month of treatment,WHOQOL-100 scores were higher in two groups,which were higher in the research group than that in the control group( P < 0. 05). [Conclusions]DLT can significantly reduce the level of serum inflammatory factors,improve the quality of life in patients with CHD and phlegm and blood stasis syndrome.

Combined effects of hypertension and angiotensin Ⅱ on the risk of coronary heart disease:a population-based prospective cohort study among Inner Mongolians in China

Objective To investigate the combined effects of hypertension and angiotensinⅡon the risk of coronary heart disease(CHD)on the basis of a 10-year prospective study in an Inner Mongolian population of China.Methods Based on a cross-sectional survey,a prospective cohort study was conducted from June 2003 to July 2012 among 2,530 Mongolian people.

Reducing cholesterol to prevent coronary heart disease

Coronary heart disease (CHD) remains the number one killer of men and women in the United States of America despite major advances in interventional technologies for the treatment of coronary artery disease. CHD is rapidly becoming a major cause of morbidity and mortality in developing nations as well and is now recognized as the leading cause of death worldwide.

Depression as a risk factor for coronary heart disease—How strong is the evidence?

A critical appraisal is made of the evidence that depression is a causal risk factor for coronary heart disease. PubMed and Science Citation Index were searched for relevant papers. Forty eight papers satisfying inclusion criteria and reporting an association between a measure of depression and a coronary disease outcome were compared in terms of baseline assessment, exposure and endpoint definition, covariates measured and whether changes in, or treatment of, depression was assessed during follow-up. There was considerable variation in the definition of depression and coronary heart disease and contradictory findings are reported. Conventional risk factors for coronary heart disease were not assessed consistently or adequately. Only three of the forty-eight papers gave consideration to the time course of depression during follow-up and prior to study entry. Potentially confounding variables such as anxiety, personality traits and other psychiatric disorders were not taken into consideration in the majority of papers. Treatment of depression during the follow-up period was not mentioned in any of the papers. In light of identified methodological shortcomings and the inconsistent findings reported we suggest that there is as yet no convincing evidence that depression is an independent causal risk factor for coronary heart disease.