Association of depressive symptoms and cardiovascular health with mortality among U.S. adults

Depression and cardiovascular health (CVH) are interconnected, and both are independently associated with mortality. However, the joint effects of depressive symptoms and CVH on mortality remain unclear.

By utilizing the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we included 18,679 adults aged ≥20 years without cardiovascular diseases (CVD). The definition of elevated depressive symptoms was based on the Patient Health Questionnaire-9 (PHQ-9) scores≥10. CVH was evaluated by Life's Essential 8 (LE8) and categorized into low (<50), moderate (50-80), or high (≥80). The joint association of depressive symptoms and CVH with mortality was examined utilizing multivariate Cox proportional hazard models.

Elevated depressive symptoms were associated with higher mortality risks, and CVH could explain 12.7 % and 13.7 % of the associations between depression and all-cause and non-CVD mortality, respectively. No significant interactions were found between CVH and depressive symptoms on mortality. High CVH attenuated the all-cause mortality risk in patients with elevated depressive symptoms (HR, 0.20; 95 % CI: 0.05-0.89). Compared to participants with elevated depressive symptoms and low CVH, those with no elevated depressive symptoms and high CVH had lower risks of all-cause (HR, 0.26; 95 % CI: 0.16-0.43), CVD (HR, 0.20; 95 % CI: 0.07-0.52), non-CVD mortality (HR, 0.28; 95 % CI 0.16-0.50).

Adults with low CVH and elevated depressive symptoms had significantly higher risks of all-cause, CVD, and non-CVD mortality. The finding suggests considering depressive symptoms and CVH jointly in developing targeted strategies to improve survival.