Association of Depressive Symptoms With Incident Cardiovascular Diseases in Middle-Aged and Older Chinese Adults

Abstract

Importance: The prevalence of depressive symptoms among older adults has become an increasingly important public health priority. Elevated depressive symptoms are well documented among elderly people with cardiovascular disease (CVD), but studies conducted among Chinese adults are scarce.

Objective: To estimate the association between depressive symptoms and incident CVD among middle-aged and older Chinese adults.

Design, setting, and participants: The China Health and Retirement Longitudinal Study is an ongoing nationally representative prospective cohort study that was initiated in 2011. This cohort study included 12 417 middle-aged and older Chinese adults without heart disease and stroke at baseline. Statistical analysis was conducted from April 25, 2018, to December 13, 2018.

Exposure: Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale.

Main outcomes and measures: Incident CVD (ie, self-reported physician-diagnosed heart disease and stroke combined) was followed-up from June 1, 2011, to June 31, 2015. The Center for Epidemiologic Studies Depression Scale total score ranges from 0 to 30, with a score of 12 or more indicating elevated depressive symptoms.

Results: Of the 12 417 participants (mean [SD] age at baseline, 58.40 [9.51] years), 6113 (49.2%) were men. During the 4 years of follow-up, 1088 incident CVD cases were identified. Elevated depressive symptoms were independently associated with an increased CVD risk (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.58) after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.39) and loneliness (adjusted hazard ratio, 1.21; 95% CI, 1.02-1.44), were significantly associated with incident CVD.

Conclusions and relevance: Elevated depressive symptoms overall and 2 individual symptoms (restless sleep and loneliness) were significantly associated with incident CVD among middle-aged and older Chinese adults.

Figure 1.. Adjusted Hazard Ratios (HRs) of Cardiovascular Disease Events Risk, According to Depressive Symptoms Scores

Graphs show HRs for cardiovascular disease (A), heart disease (B), and stroke (C) adjusted for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Data were fitted by a restricted cubic spline Cox proportional hazards regression model. The depressive symptoms score ranges from 0 to 30, with the highest score representing the lowest risk of depressive symptoms. Solid lines indicate HRs, and dashed lines indicate 95% CIs.

Figure 2.. Association Between Depressive Symptoms and Cardiovascular Disease Events Risk Stratified by Different Factors

Graphs show hazard ratios (HRs) and 95% CIs for cardiovascular disease (A), heart disease (B), and stroke (C) adjusted for age, sex, residence, marital status, educational level, smoking status, drinking status, and body mass index (calculated as the weight in kilograms divided by height in meters squared); and history of diabetes, hypertension, dyslipidemia, chronic kidney disease.