Risk of Cardiovascular Disease Mortality in Relation to Depression and 14 Common Risk Factors

Abstract

Background: Depression has been linked to a worse prognosis of Cardiovascular disease (CVD), and these two diseases share a variety of common risk factors such as unhealthy lifestyles and chronic medical conditions. However, the potential role of these common risk factors in modulating the association between depression and CVD mortality and whether the co-occurrence of depression and a specific common risk factor has a cumulative impact on CVD mortality are still largely unknown.

Methods: We pooled data from 2005-2014 of Nation health and nutritional examination survey, leading to a study population of 22,177 adults. The Patient Health Questionnaire was employed to assess the depression symptoms, and information on CVD mortality was obtained from the linked mortality file of NHANES. Fourteen common risk factors of depression and CVD were included in this study.

Results: Based on the interaction analyses, we found overweight was protective for the risk of CVD death in depressive participants, but not in people without depression. Moreover, relative risk-based analyses indicated a mutually promotive effect of depression and baseline CVD or living alone on CVD mortality.

Conclusion: The novel findings in our study may facilitate risk stratification in the clinical programs targeting CVD mortality and help to shed light on the differential pathophysiological mechanisms in the depression-mediated elevation of CVD mortality.

Keywords: NHANES; cardiovascular disease mortality; depression; epidemiology.

Figure 1

Participants enrollment flowchart including exclusion criteria-NHANES 2005–2014.

Figure 2

Adjusted dose–response association between BMI/WC and risk for CVD mortality in participants with (A) and without (B) depression. Y-axis represents the adjusted hazard ratio of CVD mortality for a given BMI/WC value compared with a referent level of 5th percentile of its distribution. The model was adjusted for age, sex, race/ethnicity, education and poverty income ratio.

Figure 3

Multivariable-adjusted hazard ratio for CVD mortality by statuses of depression and each of the 14 common risk factors. The model was adjusted for age, sex, race/ethnicity, education, poverty income ratio, smoking, alcohol use, activity, BMI, period, congestive heart failure, coronary heart disease, angina, angina pectoris, heart attack, diabetes, high blood pressure or hypertension, cancer or malignancy of any kind, and stroke.

Figure 4

Survival curves (A) and weighted CVD mortality (B) by statuses of depression and living alone, BMI, WC or baseline CVD.