Mental Health Disorders and the Development of Cardiovascular Disease: Insights from the All of Us Research Program

Area of Science:

• Cardiology
• Psychiatry
• Public Health

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality globally.
• Mental health disorders (MHDs) are increasingly recognized as potential risk factors for various chronic conditions.
• The relationship between MHDs and incident CVD in individuals without pre-existing cardiovascular conditions requires further elucidation.

Purpose of the Study:

• To investigate the association between self-reported MHDs and the incidence of future cardiovascular events.
• To determine if specific MHDs confer a differential risk for myocardial infarction (MI), stroke, and heart failure (HF).
• To explore potential sex-based differences in the association between MHDs and CVD incidence.

Main Methods:

• Prospective analysis of a large cohort from the All Of Us Research Program (N=119,740).
• Examined four MHDs: anxiety disorder, bipolar disorder, depression, and post-traumatic stress disorder (PTSD).
• Utilized Cox regression models, adjusting for key demographic and clinical covariates, to calculate hazard ratios (HR) for incident CVD events.

Main Results:

• All studied MHDs were significantly associated with increased risks of heart failure (HF) and composite cardiovascular disease (CVD).
• Specific HRs for HF ranged from 1.25 for depression to 1.57 for bipolar disorder.
• Subgroup analysis revealed that MHDs were associated with total CVD in females but not in males.

Conclusions:

• Individuals with MHDs, even without prior CVD, exhibit a heightened risk of developing future cardiovascular events, especially HF.
• The observed association between MHDs and CVD incidence was more pronounced in women.
• Integrating mental health assessments into cardiovascular prevention strategies is crucial for comprehensive patient care.