He Jie, Liu Mingyue, Zhang Ziying, Fang Mingzhu, Wu Liang, Wu Haisheng, Li Zhe
Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Sports Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, China.
Front Psychiatry. 2025 Jul 2;16:1559092. doi: 10.3389/fpsyt.2025.1559092. eCollection 2025.
Although cardiovascular disease (CVD) and depressive symptoms frequently co-occur, their temporal directional relationship remains poorly understood. This study aimed to investigate the bidirectional association between depression and CVD in middle-aged and elderly Chinese adults through longitudinal analyses.
This longitudinal cohort study included 12792 participants from the China Health Retirement Longitudinal Study (CHARLS), 2015-2020. Depressive symptoms were defined as a score of 10 or higher on the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). Cardiovascular disease (CVD) was defined as physician-diagnosed coronary heart disease (CHD) and/or stroke. Cox proportional hazards models were applied to investigate the longitudinal association of baseline depressive symptoms with follow-up CVD events, as well as the association of baseline CVD status with follow-up depressive symptoms. Cross-lagged panel models were performed to evaluate bidirectional associations and strength of temporal relationships simultaneously. Effect modification by demographic and lifestyle factors was also examined to identify vulnerable populations for each directional pathway.
Of 12792 participants, the mean (SD) age was 60.8 (8.9) years and 6833 (53.4%) were females. After adjusting for potential confounders, baseline depressive symptoms were associated with higher risks of subsequent CVD (HR=1.55, 95% CI: 1.40-1.72), CHD (HR=1.51, 95% CI: 1.34, 1.70), and stroke (HR=1.71, 95% CI: 1.43-2.04); conversely, baseline conditions of CVD (HR=1.22, 95% CI: 1.10-1.35), CHD (HR=1.20, 95% CI: 1.08-1.33) and stroke (HR=1.43, 95% CI: 1.16-1.77) were associated with increased risk of depressive symptoms at follow-up. The cross-lagged panel analysis further confirmed the bidirectional associations over time (all -values < 0.001), revealing that the standardized effect size of CVD status on depressive symptoms was greater than the effect size in the reverse direction. The directional pathway from depressive symptoms to CVD was modified by body mass index, educational level, residence, and alcohol consumption, while the reverse directional association was modified by education level and alcohol consumption.
There is a longitudinal, bidirectional association between CVD status and depressive symptoms in mid-to-late life, with CVD status emerging as a larger driving force in these dynamic interactions. These findings suggest that targeted interventions addressing either CVD or depressive symptoms may yield reciprocal benefits over time.
虽然心血管疾病（CVD）和抑郁症状经常同时出现，但其时间上的方向性关联仍知之甚少。本研究旨在通过纵向分析探讨中国中老年成年人抑郁与心血管疾病之间的双向关联。
这项纵向队列研究纳入了中国健康与养老追踪调查（CHARLS）2015 - 2020年的12792名参与者。抑郁症状被定义为在10项流行病学研究中心抑郁量表（CES - D - 10）上得分10分及以上。心血管疾病（CVD）被定义为医生诊断的冠心病（CHD）和/或中风。采用Cox比例风险模型研究基线抑郁症状与随访心血管疾病事件的纵向关联，以及基线心血管疾病状态与随访抑郁症状的关联。进行交叉滞后面板模型以同时评估双向关联和时间关系的强度。还检查了人口统计学和生活方式因素的效应修正，以确定每个方向性途径的脆弱人群。
在12792名参与者中，平均（标准差）年龄为60.8（8.9）岁，女性有6833名（53.4%）。在调整潜在混杂因素后，基线抑郁症状与后续心血管疾病（HR = 1.55，95%CI：1.40 - 1.72）、冠心病（HR = 1.51，95%CI：1.34，1.70）和中风（HR = 1.71，95%CI：1.43 - 2.04）的较高风险相关；相反，心血管疾病（HR = 1.22，95%CI：1.10 - 1.35）、冠心病（HR = 1.20，95%CI：1.08 - 1.33）和中风（HR = 1.43，95%CI：1.16 - 1.77）的基线状况与随访时抑郁症状风险增加相关。交叉滞后面板分析进一步证实了随时间的双向关联（所有p值<0.001），表明心血管疾病状态对抑郁症状的标准化效应大小大于反向效应大小。从抑郁症状到心血管疾病的方向性途径受到体重指数、教育水平、居住地和饮酒的影响，而反向关联则受到教育水平和饮酒的影响。
中老年时期心血管疾病状态与抑郁症状之间存在纵向双向关联，在这些动态相互作用中，心血管疾病状态是更大的驱动力。这些发现表明，针对心血管疾病或抑郁症状的有针对性干预可能会随着时间产生相互益处。
