Dr. Wulsin opened his presentation by noting that he had reviewed the English-language literature on depression and coronary artery disease from 1966 to 2000.
He explained that he examined the role of depression as a risk factor on the basis of seven criteria:
1) strength of association,
2) prediction,
3) specificity,
4) consistency,
5) dose-response effect,
6) biological plausibility,
and 7) response to treatment.
Throughout the presentation, he discussed the literature with respect to each criterion

Dr. Wulsin found that depression was consistently associated with coronary artery disease in over 50 studies.
Some of those studies reported significant depression in patients with coronary artery disease, while other studies described depressed patients who developed coronary artery disease.
Depression independently predicted onset of coronary artery disease in 8 studies.

Dr. Wulsin noted large variability in the specificity of the measures and associations in the studies he reviewed.
He remarked "Coronary artery disease correlated most strongly with depression." The dose-response articles found increased risk for coronary artery disease with increasing severity of depression in 9 out of 10 studies.
There was little evidence in the areas of biological plausibility and response to treatment.
Dr. Wulsin reviewed some hypotheses in the area of biological plausibility.
These included dysregulation of the hypothalamic-pituitary-adrenal axis, decreased heart rate variability, and platelet dysfunction.

Dr. Wulsin believes that evidence for the role of depression as a risk factor for onset and progression of coronary artery disease is growing, but is not yet established because of insufficient evidence pertaining to specificity, biological plausibility, and response to treatment.
Noting the need for more basic research and controlled treatment studies, he nevertheless believes that depression will prove to be an important risk factor for onset and progression of coronary artery disease.