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Chest pain

Depression Influences Chest Pain Localisation and Predictive Value for Coronary Artery Disease

Strategic Insights

— 2 min read

According to a recent study published in the Canadian Journal of Cardiology, researchers have found that depression is independently associated with chest pain and increased cardiovascular risk, regardless of coronary artery disease (CAD) status. The study, conducted at the University of Toronto, analyzed data from the National Health and Nutrition Examination Survey from 2005 to 2020 and found that depressed individuals more frequently reported chest pain in the lower sternum, left chest, and epigastrium. The findings suggest that depression modifies the predictive value of chest pain localisation for CAD, and a 'depressed chest pain profile' involving nontraditional locations was more strongly associated with CAD in those with depression.

Key Takeaways:

  • Depressed individuals are more likely to report chest pain in the lower sternum, left chest, and epigastrium compared to nondepressed individuals.
  • A 'depressed chest pain profile' involving nontraditional locations is more strongly associated with CAD in individuals with depression.
  • A 'nondepressed pain profile' involving typical regions such as the chest and upper sternum is more predictive of CAD in nondepressed individuals.
  • The predictive value of chest pain localisation for CAD is influenced by the presence of depression.
  • Depression modifies the relationship between chest pain and CAD risk, highlighting the importance of integrating mental health context into chest pain evaluation.
  • The study analyzed data from 2208 individuals from the National Health and Nutrition Examination Survey from 2005 to 2020.
  • The researchers used survey-weighted propensity score matching to create depression-stratified cohorts and compared chest pain localisation and inter-regional correlations.
  • Random forest models with survey-weighted bootstrap replicates were used to estimate the relative importance of pain locations in predicting CAD, stratified by depression status.

Statistics:

  • 2208 individuals were matched from the survey data, with 1104 per cohort.
  • Depressed individuals had a higher frequency of chest pain in the lower sternum (P = 0.045), left chest (P = 0.002), and epigastrium (P = 0.039) compared to nondepressed individuals.
  • The study found that atypical pain regions (epigastrium, lower sternum, neck, arms) were more predictive of CAD in depressed individuals, whereas typical regions (chest, upper sternum) were stronger predictors in nondepressed individuals.

Sources:

  • "Machine Learning Reveals How Depression Influences Chest Pain Localisation and Its Predictive Value for Coronary Artery Disease" by Mohsyn Imran Malik, Wendy Lou, Gianluigi Bisleri, Kim Connelly, and Venkat Bhat in the Canadian Journal of Cardiology, 2025.
  • NewsRx. New Heart Disease Study Findings Have Been Reported by Researchers at University of Toronto (Machine Learning Reveals How Depression Influences Chest Pain Localisation and Its Predictive Value for Coronary Artery Disease). Cardiovascular Week. November 3, 2025; p 56.

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