Life's essential 8 cardiovascular health and depression: Sex-specific associations in a national population-based...

Depression represents a significant global health burden. While cardiovascular health and depression share a well-established association, the specific relationship between "Life's Essential 8 (LE8)" and depression remains underexplored.

Utilizing data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018), LE8 scores based on American Heart Association guidelines, categorizing cardiovascular health into low (<50), moderate (50-79), and high (≥80) tiers. Depression was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10. Survey-weighted logistic regression, restricted cubic splines, and mediation analysis were employed to assess associations.

Among the weighted sample of 213,703,729.8 participants (mean age 45.21 years, 50.6 % male), each 1-standard deviation (SD) increase in the LE8 score, the adjusted odds ratio for depression was 0.64 (95 % CI: 0.56-0.73). Compared to the low LE8 group, high and moderate LE8 tiers exhibited substantially lower depression risks (high: OR = 0.29, 95 % CI: 0.18-0.48; moderate: OR = 0.52, 95 % CI: 0.37-0.74, both P < 0.001). Individuals with ≥5 optimal LE8 components demonstrated a 67 % risk reduction versus those with 0-1 components (OR = 0.33, 95 % CI: 0.19-0.57), with each additional component lowering risk by 23 % (OR = 0.77, 95 % CI: 0.66-0.90). Subgroup analyses revealed sex-specific variations: diet contributed most to risk reduction in males (attributable risk proportion = 0.053), while BMI was predominant in females (0.052). Mediation analyses identified cardiovascular disease (CVD; 29 % mediation) and obstructive sleep apnea (OSA; 12.2 % mediation) as partial mechanistic pathways.

LE8 scores exhibit a robust inverse association with depression risk, modulated by sex-specific component contributions and mediated through CVD and OSA. These findings underscore the value of tailored interventions.