Changes in depressive symptoms and risk of incident heart disease: a multi-cohort longitudinal analysis

Depressive symptoms have been linked to cardiovascular morbidity, but most studies rely on single-time assessments and may overlook the cumulative impact of persistent psychological distress. We examined whether longitudinal change patterns of depressive symptoms were associated with incident heart disease across three nationally representative aging cohorts.

We analyzed 19,818 middle-aged and older adults without baseline heart disease from the China Health and Retirement Longitudinal Study, the Health and Retirement Study, and the English Longitudinal Study of Ageing. Depressive symptoms were assessed across three or four consecutive waves and classified into four change patterns: consistently low, decreasing, increasing, and persistent. To address potential reverse causation, participants who developed heart disease during the depressive symptom assessment period were excluded. Incident heart disease was defined by new self-reported physician diagnosis during follow-up. Multivariable logistic regression estimated odds ratios and 95% confidence intervals after adjustment for demographic factors, lifestyle behaviors, and comorbidities. Inverse probability weighting was used as a sensitivity analysis to account for potential selection bias.

The persistent depressive symptom pattern was consistently associated with higher odds of incident heart disease compared to the low/minimal symptom pattern across all three cohorts. The fully adjusted ORs were 1.720 (95% CI: 1.358-2.179) in CHARLS, 1.438 (95% CI: 1.192-1.734) in HRS, and 2.252 (95% CI: 1.282-3.955) in ELSA. Decreasing and increasing symptom patterns did not demonstrate stable significant associations with heart disease risk after full adjustment. IPW-adjusted sensitivity analyses yielded consistent results (Table S3). Trend tests confirmed that a higher cumulative burden of depressive symptoms was linked to a greater risk of heart disease.

Persistent depressive symptoms, rather than transient or changing symptoms, were consistently associated with elevated heart disease risk in aging populations from China, the United States, and England. These findings highlight the importance of incorporating long-term mental health patterns into cardiovascular risk assessment and prevention strategies.