Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA‐Brasil

Brunoni, André R.; Szlejf, Cláudia; Suemoto, Cláudia Kimie; Santos, Itamar S; Goulart, Alessandra Carvalho; Viana, María Carmen; Koyanagi, Ai; Barreto, Sandhi Maria; Moreno, Arlinda B.; Carvalho, André F.; Lange, Shannon; Griep, Rosane Härter; Lotufo, Paulo A

doi:10.1111/acps.13109

Cited by 15 publications

(14 citation statements)

References 56 publications

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“… 29 The most consistent associations were seen for depressive symptoms and the behavioral CVH factors (smoking, physical activity, and diet) as well as BMI, as seen in our study. Notably, the 3 prospective studies included in this review found that individuals with worsening depression over time were more likely to have lower CVH scores later in life 24 and that individuals with higher CVH were less likely to develop depression in future years, 22 , 25 suggesting a bidirectional nature to this relationship. While there have been fewer studies of the relationship between anxiety and CVH, our results are consistent with the lower CVH scores found in those with anxiety in cohorts from China 28 and Brazil.…”

Section: Discussionmentioning

confidence: 95%

“…Our results are consistent with other studies that have found strong correlations between these mental health factors and cardiovascular health among older adults. The 2022 systematic review of associations between depressive symptoms and CVH 14 included studies from the United States, 20 , 21 , 22 , 23 , 24 Brazil, 15 , 25 Finland, 26 China, 27 , 28 and France. 29 The most consistent associations were seen for depressive symptoms and the behavioral CVH factors (smoking, physical activity, and diet) as well as BMI, as seen in our study.…”

Section: Discussionmentioning

confidence: 99%

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Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults

Patterson

Marcus

Goetz

et al. 2022

JAHA

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Background Cardiovascular health (CVH) declines in young adulthood, and mood disorders commonly emerge during this life stage. This study examined the association between depression, anxiety, and CVH metrics among young adults. Methods and Results We conducted a cross‐sectional analysis of participants aged 18 to 34 years who completed the Emory Healthy Aging Study Health History Questionnaire (n=875). We classified participants as having poor, intermediate, or ideal levels of the 8 CVH metrics using definitions set forth by the American Heart Association with adaptions when necessary. We defined depression and anxiety as absent, mild, or moderate to severe using standard cutoffs for Patient Health Questionnaire and General Anxiety Disorder scales. We used multivariable regression to examine the association between depression and anxiety and CVH, adjusting for age, sex, race and ethnicity, income, and education. The mean participant age was 28.3 years, and the majority identified as women (724; 82.7%); 129 (14.7%) participants had moderate to severe anxiety, and 128 (14.6%) participants had moderate to severe depression. Compared with those without anxiety, participants with moderate to severe anxiety were less likely to meet ideal levels of physical activity (adjusted prevalence ratio [aPR], 0.60 [95% CI, 0.44–0.82]), smoking (aPR, 0.90 [95% CI, 0.82–0.99]), and body mass index (aPR, 0.79 [95% CI, 0.66–0.95]). Participants with moderate to severe depression were less likely than those without depression to meet ideal levels of physical activity (aPR, 0.48 [95% CI, 0.34–0.69]), body mass index (aPR, 0.75 [95% CI, 0.61–0.91]), sleep (aPR, 0.79 [95% CI, 0.66–0.94]), and blood pressure (aPR, 0.92 [95% CI, 0.86–0.99]). Conclusions Anxiety and depression are associated with less ideal CVH in young adults. Interventions targeting CVH behaviors such as physical activity, diet, and sleep may improve both mood and CVH.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults

Patterson

Marcus

Goetz

et al. 2022

JAHA

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“…Thus, a higher predicted CVD risk was strongly associated with a higher future incidence of depression, both in younger and older adults un the SUN cohort [ 11 ]. Also, results from the cross-sectional and a longitudinal analysis of the ELSA-Brazil study, where healthy adults were classified into poor, intermediate, and optimal cardiovascular health [ 23 ], showed that poor cardiovascular health is associated with depression [ 10 ], and triples the risk of depression after almost 4 years of follow up [ 9 ] in otherwise healthy adults. Furthermore, these effects were more pronounced in women and in participants younger than 55 years old.…”

Section: Discussionmentioning

confidence: 99%

“…Although it has been shown that depression could be a risk factor for CVD [ 6 , 7 ], studies situating cardiovascular risk (CVR) as risk factor for developing depression are scarce [ 8 ]. Some studies have investigated cardiovascular health index on depression onset [ 9 , 10 ], in young adults [ 11 ] or in middle age populations. On the other hand, depressive disorders among CVD patients are still under-recognized and under-treated, particularly in women [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Contribution of cardio-vascular risk factors to depressive status in the PREDIMED-PLUS Trial. A cross-sectional and a 2-year longitudinal study

et al. 2022

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Background Cardio-vascular disease and depression are thought to be closely related, due to shared risk factors. The aim of the study was to determine the association between cardio-vascular risk (CVR) factors and depressive status in a population (55–75 years) with metabolic syndrome (MetS) from the PREDIMED-Plus trial. Methods and findings Participants were classified into three groups of CVR according to the Framingham-based REGICOR function: (1) low (LR), (2) medium (MR) or (3) high/very high (HR). The Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms at baseline and after 2 years. The association between CVR and depressive status at baseline (n = 6545), and their changes after 2 years (n = 4566) were evaluated through multivariable regression models (logistic and linear models). HR women showed higher odds of depressive status than LR [OR (95% CI) = 1.78 (1.26, 2.50)]. MR and HR participants with total cholesterol <160 mg/mL showed higher odds of depression than LR [OR (95% CI) = 1.77 (1.13, 2.77) and 2.83 (1.25, 6.42) respectively)] but those with total cholesterol ≥280 mg/mL showed lower odds of depression than LR [OR (95% CI) = 0.26 (0.07, 0.98) and 0.23 (0.05, 0.95), respectively]. All participants decreased their BDI-II score after 2 years, being the decrease smaller in MR and HR diabetic compared to LR [adjusted mean±SE = -0.52±0.20, -0.41±0.27 and -1.25±0.31 respectively). MR and HR participants with total cholesterol between 240–279 mg/mL showed greater decreases in the BDI-II score compared to LR (adjusted mean±SE = -0.83±0.37, -0.77±0.64 and 0.97±0.52 respectively). Conclusions Improving cardiovascular health could prevent the onset of depression in the elderly. Diabetes and total cholesterol in individuals at high CVR, may play a specific role in the precise response. International Standard Randomized Controlled Trial (ISRCTN89898870).

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“…To account for possible confounders, two adjusted models were built. Model 1 was adjusted for age and sex, and Model 2 was further adjusted for race, education, BMI, smoking, alcohol consumption, use of antidepressants/benzodiazepines, kidney function and comorbidities (diabetes, stroke, cardiovascular disease 22 and cancer). Results were presented as relative risks (RR) with their respective 95% confidence intervals (95% CI).…”

Section: Methodsmentioning

confidence: 99%

Thyroid‐stimulating hormone levels and incident depression: Results from the ELSA‐Brasil study

Varella

Janovsky

Goulart

et al. 2021

Clinical Endocrinology

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Objective This study aimed to prospectively evaluate whether TSH levels at baseline were associated with incident depression after four years of follow‐up in a cohort of middle‐aged adults, the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil). Methods TSH and free‐thyroxine (FT4) levels were evaluated at baseline. Depression diagnoses were performed using the Clinical Interview Schedule—Revised (CIS‐R) at baseline and after a 4‐year follow‐up. Poisson regression models (95% Confidence Intervals) were built to evaluate the association between TSH quintiles at baseline and incident depression. All analyses were stratified by sex. Models were presented crude, adjusted for age and sex; and further adjusted for race, education, BMI, smoking, alcohol consumption, use of antidepressants/benzodiazepines, kidney function and comorbidities. Results Mean age was 51.5 years, and 51.2% were women. Overall, low TSH levels (1st quintile) were associated with incident depression (adjusted RR = 1.36, 95% CI 1.02–1.81), remaining significant for women (adjusted RR = 1.64, 95% CI 1.15–2.33), but not for men. The same results were found when restricting analysis to euthyroid participants (adjusted RR = 1.46, 95% CI 1.08–1.99), also significant for women only (adjusted RR = 1.63, 95% CI 1.12–2.38). Conclusions Our results showed that low TSH levels were positively associated with incident depression, particularly among women. Similar results were found when restricting the analysis to euthyroid participants. In contrast, high TSH levels were inversely associated with incident depression, also among women.

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Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA‐Brasil

Cited by 15 publications

References 56 publications

Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults

Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults

Contribution of cardio-vascular risk factors to depressive status in the PREDIMED-PLUS Trial. A cross-sectional and a 2-year longitudinal study

Thyroid‐stimulating hormone levels and incident depression: Results from the ELSA‐Brasil study

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