CHD risk in depression

Inspired by Huang et al 2021.[1]

Photo by Jiroe on Unsplash.

CHD – coronary heart disease
FM – fibromyalgia
RA – rheumatoid arthritis
OA – osteoarthritis
PD – Parkinson’s disease
NHIRD – National Health Insurance Research Database (Taiwan)
aHR – adjusted hazard ratio
MA – manual acupuncture
EA – electroacupuncture

key to acronyms

This is the fourth large retrospective observational cohort from Taiwan measuring CHD risk. The first was in patients with FM,[2] the second in patients with RA,[3] and the third in patients with OA.[4] These were discussed in a previous blog: CHD risk in OA 2000–12.

It is the third such study in a cohort of patients with depression. The first examined stroke risk,[5] and the second examined the risk of developing PD.[6]

All these studies can be found in the blog category: Retrospective cohorts; which is also has a link on the blog home page, in case you want to check one of them, as I often do!

Patients with depression were selected from the NHIRD over a 14-year period from the start of 1997. 14 647 who had received acupuncture were matched with the same number who had not received acupuncture. Propensity score matching was used, and adjustments were made for the ‘immortal time’ between the date of first diagnosis with depression and the first acupuncture session. I have discussed immortal time bias previously on the blog.

Propensity score matching included all the usual items, including: sex, age, comorbidities and drugs. Acupuncture was associated with a 0.50 risk (aHR) of developing CHD in the time frame of the study. That means the risk of CHD was halved in the cohort receiving acupuncture. When looking at the individual comorbidities it seems that obesity was associated with the biggest risk reduction in the patients receiving acupuncture (aHR 0.19). If this association is a causative one, it is interesting to hypothesise about the possible mechanisms of protection in obesity. It seems likely that this might be a combination of improved metabolic factors along with a modest effect on blood pressure. Metabolic effects have been discussed before here: Metabolic effects 2020.

0.50 depression
0.19 osteoarthritis (oral steroids – 0.34)
0.64 rheumatoid arthritis (EA – 0.48, MA & EA – 0.36)
0.43 fibromyalgia

CHD risk associated with acupuncture (aHR)

0.49 stroke
0.39 Parkinson’s disease
0.50 CHD

Risk associated with acupuncture in patients with depression (aHR)


1          Huang C-Y, Huang M-C, Sun M-F, et al. Acupuncture Treatment Reduced the Risk of Coronary Heart Disease in Patients with Depression: A Propensity-Score Matched Cohort Study. Neuropsychiatr Dis Treat 2021;17:2315–25. doi:10.2147/NDT.S315572

2          Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7

3          Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5

4          Ton G, Yang Y-C, Lee L-W, et al. Acupuncture Decreased the Risk of Coronary Heart Disease in Patients with Osteoarthritis in Taiwan: A Nationwide Matched Cohort Study. J Altern Complement Med 2020;18:acm.2020.0153. doi:10.1089/acm.2020.0153

5          Chen L-Y, Yen H-R, Sun M-F, et al. Acupuncture treatment is associated with a decreased risk of developing stroke in patients with depression: A propensity-score matched cohort study. J Affect Disord 2019;250:298–306. doi:10.1016/j.jad.2019.03.020

6          Huang C-H, Lin M-C, Hsieh C-L. Acupuncture Treatment Reduces Incidence of Parkinson’s Disease in Patients With Depression: A Population-Based Retrospective Cohort Study in Taiwan. Front Aging Neurosci 2020;12:591640. doi:10.3389/fnagi.2020.591640

Declaration of interests MC