Association of Cardiovascular Health With Risk of Clinically Relevant Depressive Symptoms

Abstract

ImportanceCardiovascular health may be used for prevention of depressive symptoms. However, data on the association of cardiovascular health across midlife with depressive symptoms are lacking.ObjectiveTo evaluate whether better baseline cardiovascular health and improvement of cardiovascular health over time are associated with a lower risk of both incident depressive symptoms and unfavorable trajectories of depressive symptoms.Design, Setting, and ParticipantsParticipants without depressive symptoms were included from a prospective community-based cohort in France (GAZEL cohort). Cardiovascular health examinations occurred in 1990 and 1997 and assessment of depressive symptoms in 1997 and every 3 years thereafter until 2015. Data were analyzed from January to October 2022.ExposuresNumber of cardiovascular health metrics (smoking, body mass index, physical activity, diet, blood pressure, glucose, and cholesterol) at an intermediate or ideal level in 1997 (range, 0-7) and 7-year change in cardiovascular health between 1990 and 1997.Main Outcomes and MeasuresPrimary outcome was incident depressive symptoms (20-item Center for Epidemiologic Studies–Depression Scale [CES-D] score of 17 or greater in men or 23 or greater in women); secondary outcome was trajectories of depressive symptoms scores. Trajectories included consistently low scores, moderately elevated scores, low starting then increasing scores, moderately high starting, increasing, then remitting scores, and moderately high starting then increasing scores.ResultsOf 6980 included patients, 1671 (23.9%) were women, and the mean (SD) age was 53.3 (3.5) years. During a follow-up spanning 19 years after 1997, 1858 individuals (26.5%) had incident depressive symptoms. Higher baseline cardiovascular health in 1997 and improvement in cardiovascular health over 7 years were each associated with lower risk of depressive symptoms (odds ratio [OR] per additional metric at intermediate or ideal level at baseline, 0.87; 95% CI, 0.84-0.91; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.91; 95% CI, 0.86-0.96). Also, better cardiovascular health was associated with lower risk of unfavorable depressive symptoms trajectories. Compared with the consistently low score trajectory, the lowest risks were observed for the low starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.70; 95% CI, 0.64-0.76; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.73; 95% CI, 0.68-0.79) and the moderately high starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.71; 95% CI, 0.64-0.79; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77).Conclusions and RelevanceIn this prospective community-based cohort study of adults, higher cardiovascular health was associated with a lower risk of depressive symptoms over time. Elucidating which set of cardiovascular factors may affect depression risk could be important for prevention.

Depression symptoms and suicide risk of internal medicine residents before and after first year of the COVID-19 pandemic

“…Our results contradict the results of Caruncho and Rivera-Baltanas and what is reported by Segoviano-Mendoza et al (2018) since we found an increase in depression symptoms related to a decrease in cortisol levels and an increase in serum cholesterol levels. However, they are similar to the results of other studies, such as those of van Sloten et al (2023) , who found that having better cardiovascular health, as measured by normal cholesterol levels, exercising, and having a normal BMI are favorable factors for not experiencing depression symptoms, and those of the study by Lindqvist et al (2008) which relates variability in cortisol and symptoms of depression.…”

Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

“…They have a solid clinical basis and underpin all the CVH metrics, interacting bidirectionally. 13,20,21 Previous research has revealed that poor CVH was related to depressive symptoms 22,23 and social isolation. 24 Another study found an effect modification by CVH on the relationship between socioeconomic status and life expectancy.…”

Cardiovascular health (“Life’s Essential 8”), risk of depression and anxiety: a prospective cohort study

“…Over the past decade, CVH was not only widely employed to estimate the risks of cardiovascular events and cognitive health [9][10][11] , but also the risk of depression. Recently, a prospective community-based cohort of 6,980 participants in France found that better CVH was associated with a lower risk of depressive symptoms over time 12 . It is line with a longitudinal analysis of ELSA-Brasil included 9,214 participants also suggested that poor cardiovascular health tripled depression risk at follow-up in otherwise healthy adults 13 .…”