Pu Boxuan, Wang Wei, Lei Lubi, Li Jingkuo, Peng Yue, Yu Yanwu, Zhang Lihua, Yuan Xin
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
J Psychosom Res. 2025 Feb;189:112032. doi: 10.1016/j.jpsychores.2024.112032. Epub 2025 Jan 4.
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.
抑郁症与心血管健康（CVH）相互关联，且二者均与死亡率独立相关。然而，抑郁症状和CVH对死亡率的联合影响仍不明确。
利用2007 - 2018年美国国家健康与营养检查调查（NHANES），我们纳入了18679名年龄≥20岁且无心血管疾病（CVD）的成年人。抑郁症状加重的定义基于患者健康问卷-9（PHQ - 9）得分≥10。CVH通过生命八大要素（LE8）进行评估，并分为低（<50）、中（50 - 80）或高（≥80）。利用多变量Cox比例风险模型检验抑郁症状和CVH与死亡率的联合关联。
抑郁症状加重与较高的死亡风险相关，CVH分别可解释抑郁症与全因死亡率和非CVD死亡率之间关联的12.7%和13.7%。未发现CVH与抑郁症状对死亡率有显著交互作用。高CVH降低了抑郁症状加重患者的全因死亡风险（风险比[HR]，0.20；95%置信区间[CI]：0.05 - 0.89）。与抑郁症状加重且CVH低的参与者相比，无抑郁症状加重且CVH高的参与者全因死亡风险较低（HR，0.26；95% CI：0.16 - 0.43），CVD死亡风险较低（HR，0.20；95% CI：0.07 - 0.52），非CVD死亡风险较低（HR，0.28；95% CI：0.16 - 0.50）。
CVH低且抑郁症状加重的成年人全因、CVD和非CVD死亡风险显著更高。该发现表明，在制定提高生存率的针对性策略时应同时考虑抑郁症状和CVH。
