Eight-year total, cognitive-affective, and somatic depressive symptoms trajectories and risks of cardiac events

Abstract

In this study, we analyzed pooled data from two prospective population-based cohorts-the Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA)-to explore the association between trajectories of depressive symptoms and the risk of cardiac events. Depressive symptoms were assessed using the 8-item CES-D scale and categorized into somatic and cognitive-affective subtypes. Trajectories were tracked for four surveys from baseline. Heart disease was identified based on self-reported physician-diagnosed conditions. Hazard ratios and 95% confidence intervals were calculated with Cox proportional risk models that adjusted for potential confounders. In total, 17,787 subjects (59.7% female, median age 63 years) were enrolled at baseline. During a 10-year follow-up, 2409 cases of heart disease were identified. Participants with fluctuating (HR = 1.13, 95% CI: 1.06-1.20), increasing (HR = 1.43, 95% CI: 1.25-1.64), and consistently high (HR = 1.64, 95% CI: 1.45-1.84) depressive symptom trajectories exhibited an increased risk of heart disease compared to those with consistently low depressive symptoms, while a decreasing (HR = 1.07, 95% CI: 0.96-1.19) depressive symptom trajectory did not significantly affect the risk of heart disease. Moreover, the association between heart disease and somatic depressive symptoms was found to be stronger than with cognitive-affective symptoms. These findings suggest a significant link between depressive symptom trajectories and heart disease, with particular emphasis on stronger associations with somatic symptoms. It is recommended that the identification and management of depressive symptoms be incorporated into heart disease prevention strategies.

Fig. 1. Flow chart for the study population.

The flowchart illustrates the inclusion and exclusion process for this study population.

Fig. 2. Forest plot visualization of Model 1 results from Table 2.

This forest plot visually represents the hazard ratios (HRs) and 95% confidence intervals (CIs) for each variable in Model 1 from Table 2. Each horizontal line corresponds to a different variable, with the square indicating the point estimate (HR) and the horizontal line representing the 95% confidence interval. The vertical dashed line denotes the null value (HR = 1), indicating no effect of the variable.

Fig. 3. Forest plot visualization of Model 2 results from Table 2.

This forest plot visually represents the hazard ratios (HRs) and 95% confidence intervals (CIs) for each variable in Model 2 from Table 2. Each horizontal line corresponds to a different variable, with the square indicating the point estimate (HR) and the horizontal line representing the 95% confidence interval. The vertical dashed line denotes the null value (HR = 1), indicating no effect of the variable.

Fig. 4. Forest plot visualization of Model 3 results from Table 2.

This forest plot visually represents the hazard ratios (HRs) and 95% confidence intervals (CIs) for each variable in Model 3 from Table 2. Each horizontal line corresponds to a different variable, with the square indicating the point estimate (HR) and the horizontal line representing the 95% confidence interval. The vertical dashed line denotes the null value (HR = 1), indicating no effect of the variable.