Association of Depression With 10-Year and Lifetime Cardiovascular Disease Risk Among US Adults, National Health and Nutrition Examination Survey, 2005-2018

Abstract

Introduction: Although an association between depression and incident cardiovascular disease (CVD) risk has been established, no US studies have quantified this association using standard primary care assessments or among younger adults who are not routinely screened for CVD risk. We estimated the association of mild and major depression with 1) 10-year atherosclerotic CVD (ASCVD) risk for people aged 40 to 79 years and 2) high lifetime CVD risk prevalence for people aged 20 to 39 years.

Methods: We conducted a cross-sectional analysis of data from the 2005-2018 National Health and Nutrition Examination Survey for adults aged 20 to 39 years (n = 10,588) and adults aged 40 to 79 years (n = 16,848). We used the Patient Health Questionnaire-9 [PHQ-9] to classify no depression (PHQ-9 score, 0-4), mild depression (PHQ-9 score, 5-9) and major depression (PHQ-9 score ≥10).

Results: Among women aged 40 to 79, ASCVD absolute risk was 6.0% for no depression, 6.9% for mild depression, and 7.6% for major depression (P < .001 vs no depression). Among men aged 40 to 79, the corresponding absolute ASCVD risks were 9.9%, 11.1%, and 11.3%, respectively (P < .001 vs no depression). High lifetime CVD risk prevalence for women aged 20 to 39 was 41.9% for no depression, 53.2% for mild depression, and 66.5% for major depression (P < .001 vs no depression). For men aged 20-39 the corresponding high lifetime risk percentages were 53.3%, 64.8%, and 74.4% respectively (P < .001 vs no depression).

Conclusion: Mild and major depression are associated with elevated 10-year ASCVD risk and substantially elevated lifetime CVD risk among younger people ineligible for ASCVD risk assessment. Jointly addressing depression and CVD risk and extending prevention efforts to younger adults are warranted.

Figure

High (≥39%) lifetime cardiovascular disease risk prevalence, by sex and depression status, men and women aged 20 to 39 years, National Health and Nutrition Examination Survey, 2005–2018. Depression was measured by using the Patient Health Questionnaire-9 (PHQ-9). Depression was categorized as not depressed (score, 0–4), mild depression (score 5–9), and major depression (score ≥10). High lifetime risk was categorized with no exclusions for prior CVD (14). Percentages were weighted to represent the subpopulations but are otherwise unadjusted. The solid line is the percentage of high lifetime risk among men aged 20 to 39 years without depression (53.4% [95% CI, 51.1%–55.7%]); the dashed line is the percentage of high lifetime risk among women aged 20 to 39 years without depression (42.0% [95% CI, 39.9%–44.2%]). Error bars represent 95% CIs.