Shared and distinct pathways from anxiety disorder and depression to cardiovascular disease: a UK Biobank prospective
Shinya Nakada1, Carlos Celis-Morales1,2,3,4, Jill P Pell1
1School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8TB, UK.
Insights
Anxiety disorder and depression significantly increase cardiovascular disease (CVD) risk. Lifestyle factors like smoking and physical factors like waist-hip ratio mediate this risk, but metabolic pathways differ between the two conditions.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Anxiety disorder and depression are known risk factors for cardiovascular disease (CVD).
- The specific mechanisms linking these mental health conditions to CVD require systematic investigation, especially contrasting their differences.
Purpose of the Study:
- To investigate the extent to which lifestyle, physical, and metabolic factors mediate the association between anxiety disorder and depression with incident CVD.
- To differentiate the mediating pathways for anxiety disorder and depression in relation to CVD risk.
Main Methods:
- A prospective cohort study utilizing UK Biobank data.
- Ascertainment of anxiety disorder, depression, and incident CVD through linked hospital and death records.
- Causal mediation analysis examining lifestyle, physical, and metabolic mediators using Cox proportional hazard and log-linear models.
Main Results:
- Both anxiety disorder (HR 1.62) and depression (HR 2.15) were significantly associated with increased CVD risk.
- Current smoking and higher waist-hip ratio were key lifestyle/physical mediators for both conditions.
- Systolic blood pressure mediated CVD risk for anxiety disorder (10.4%), while CRP mediated for depression (10.8%).
Conclusions:
- Lifestyle and physical factors appear to be common mediating pathways for CVD risk in both anxiety disorder and depression.
- Shared metabolic pathways between anxiety disorder and depression leading to CVD are unlikely.
- Targeting specific lifestyle and physical risk factors can help mitigate the elevated CVD risk in individuals with anxiety disorder or depression.
Aims:
Although anxiety disorder and depression increase the risk of cardiovascular disease, few studies have examined their underlying mechanisms systematically, particularly contrasting the difference between the two of them. Our study aimed to examine the extent to which lifestyle, physical and metabolic factors mediate the associations of anxiety disorder and depression with incident CVD.
Methods:
A prospective cohort study was conducted using UK Biobank. Anxiety disorder, depression, and incident CVD were ascertained through linkage to hospital and death records. A causal mediation analysis was performed for anxiety disorder and depression, separately examining multiple potential lifestyle, physical, and metabolic mediators. Cox proportional hazard models and log-linear models were used to derive indirect effect estimates and proportions mediated.
Results:
A total of 254,695 participants were included. Both anxiety disorder (HR 1.62, 95% CI 1.15-2.13) and depression (HR 2.15, 95% CI 1.75-2.64) were associated with CVD after adjusting for sociodemographic confounders. Among lifestyle and physical factors, the strongest mediators were current smoking and higher waist-hip ratio which accounted for 11.9% and 13.4% of the excess risk from anxiety disorder, and 17.3% and 14.0% from depression, respectively. The strongest metabolic mediators were systolic blood pressure for anxiety disorder (10.4%) and CRP (10.8%) for depression. Systolic blood pressure was the weakest mediator for depression (4.3%).
Conclusions:
Lifestyle and physical pathways to incident CVD may be common to both anxiety disorder and depression, but shared metabolic pathways seem unlikely. Our findings inform which risk factors to target among people with anxiety disorder or depression in order to reduce their higher risk of developing CVD.
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