Cardiovascular Health Metrics Indicate Risk of Depressive Symptoms

Importance  

Cardiovascular health can be used for the prevention of depressive symptoms. However, data are lacking on the association of cardiovascular health across midlife with depressive symptoms.

Aim  

To assess whether better baseline cardiovascular health and improved cardiovascular health over time are associated with lower risk of incident depressive symptoms and unfavorable trajectories of depressive symptoms.

Design, environment and participants  

Participants without depressive symptoms from a prospective community-based cohort in France (GAZEL cohort) were included. Cardiovascular health examinations were performed 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.

Exhibitions  

Number 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 results and measures  

The primary outcome was the occurrence of depressive symptoms (score of 17 or higher in men or 23 or higher in women on the 20-item Center for Epidemiologic Studies Depression Scale [CES-D]); the secondary outcome was trajectories of depressive symptom scores.

Trajectories included consistently low scores, moderately high scores, low and then increasing initial scores, moderately high, increasing and then remitting initial scores, and moderately high and then increasing initial scores.

Results 

Of 6980 patients included, 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 people (26.5%) had incident depressive symptoms.

A higher baseline cardiovascular health assessment in 1997 and improved cardiovascular health over 7 years were associated with a 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 metric higher at the intermediate or ideal level over 7 years, 0.91; 95% CI, 0.86-0.96).

Furthermore, better cardiovascular health was associated with a lower risk of unfavorable trajectories of depressive symptoms.

Compared with the consistently low score trajectory, OR per 1 metric higher at the intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77). OR for 1 metric higher at the intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77).