Enhancing the Cardiovascular Health Construct With a Psychological Health Metric for Predicting Mortality Risk.

Area of Science:

• Cardiovascular Health
• Public Health
• Psychological Health

Background:

• The American Heart Association's Life's Essential 8 (LE8) advisory recognized psychological health's importance for cardiovascular health (CVH) but excluded it as a metric.
• This highlights a gap in comprehensively assessing overall health and mortality risk.

Purpose of the Study:

• To evaluate the association between an enhanced CVH construct, including psychological health via depression screening, and mortality risk in U.S. adults.
• To determine if incorporating psychological health improves the prediction of mortality compared to existing CVH metrics.

Main Methods:

• Utilized data from 21,183 U.S. adults (2011-2018 NHANES).
• Assessed CVH using the LE8 algorithm and two enhanced constructs incorporating psychological health (PHQ-2, PHQ-9 depression screening).
• Employed multivariable Cox proportional hazards models to compare mortality risk across CVH score categories.

Main Results:

• Enhanced CVH scores (with PHQ-2/PHQ-9) were associated with significantly lower all-cause mortality risk (69-70% reduction) compared to low scores.
• High LE8 scores also predicted lower mortality risk (65% reduction), with similar predictive performance (C-statistic ≈ 0.84) to enhanced CVH.
• Both LE8 and enhanced CVH scores predicted lower cardiovascular and cancer mortality.

Conclusions:

• A CVH construct augmented with psychological health is a strong predictor of mortality.
• Integrating psychological health, using feasible depression screening tools, into CVH metrics should be considered for clinical and public health applications.