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Molero P, De Lorenzi F, Gędek A, Strater C, Popescu E, Ortuño F, Van Der Does W, Martínez-González MA, Molendijk ML. Diet quality and depression risk: A systematic review and meta-analysis of prospective studies. J Affect Disord 2025; 382:154-166. [PMID: 40158860 DOI: 10.1016/j.jad.2025.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 03/22/2025] [Accepted: 03/25/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND The association between diet and the onset and treatment of depression is unclear. This study aims to estimate the evidence for the prospective association between diet quality and depression. METHODS Systematic searches in PubMed, Web of Science and Embase up to 2024/01/04 of propective studies on the potential relationship between diet quality and depression identified 21 randomized clinical trials (RCT) and 92 prospective cohorts (PC) (>700,000 participants), that were pooled in random-effects frequentist and Bayesian meta-analyses. RESULTS Treatment-RCT yielded anecdotal-to-moderately strong support for the hypothesis that dietary interventions improve depression (d = -0.80, 95 % CI = -1.46 to -0.14), though their internal validity was low. Interventional effects were observed in nonpatient samples (d = -0.17, -0.29 to -0.08). Prevention-RCT yielded strong evidence indicating no association. Data from PC showed that adherence to some dietary patterns/food groups was associated with depression, e.g., adherence to the Mediterranean-diet was associated to fewer self-reported symptoms (OR = 0.91, 95%CI = 0.88-0.96), with anecdotal-to-moderate strength of evidence but no dose-response relationship. For most dietary patterns and food-groups (e.g., fish), data supported the null-hypothesis of no effect. Effect moderation was present: associations were evident when depression was self-reported but not when diagnosed. Postpartum-depression studies yielded evidence showing dose-response associations between fish (OR = 0.84, 95%CI = 0.78-0.91) and dietary DHA/EPA/Omega3 consumption (OR = 0.84, 95%CI = 0.77-0.92) with self-reported depression-scores. CONCLUSIONS The strength of the current evidence on the hypothesis that dietary quality influences depression outcome is very low, due to reverse causation and low internal and construct validity. The clinical significance of fish/dietary DHA/EPA/Omega3 intake to reduce the risk of postpartum-depression should be further investigated.
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Affiliation(s)
- Patricio Molero
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Francesco De Lorenzi
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Adam Gędek
- Department of Pharmacology & Third Department of Psychiatry, Institute of Psychiatry and Neurology Warsaw, Poland
| | - Celina Strater
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Elena Popescu
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Felipe Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Willem Van Der Does
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Miguel Angel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Navarra, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, United States; CIBER-OBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Marc L Molendijk
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
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Yang J, Wang Y, Zheng X, Wang H, Song G. The Relationship Between Physical Activity and Depression Among Middle-Aged and Elderly Chinese: A Longitudinal Study. Scand J Med Sci Sports 2025; 35:e70073. [PMID: 40377964 DOI: 10.1111/sms.70073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 04/23/2025] [Accepted: 05/06/2025] [Indexed: 05/18/2025]
Abstract
This study aimed to explore the association between physical activity and depression risk among middle-aged and elderly Chinese using both cross-sectional and longitudinal data. A total of 3564 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. The cross-sectional analysis of 2020 data revealed a U-shaped dose-response relationship between physical activity levels and depression risk. Longitudinally, group-based trajectory modeling identified five distinct physical activity patterns from 2011 to 2020. Compared to the low-stable group, the moderate-stable group showed a 47% reduced risk of depression, while the highest-stable group had a 37% increased risk. Gender-stratified analyses showed that long-term moderate physical activity had protective effects in both males and females, whereas excessive activity was only associated with higher depression risk in females. These findings suggest that physical activity can serve as both a protective and risk factor for depression, with gender-specific considerations in older adults.
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Affiliation(s)
| | - Yi Wang
- Department of Physical Education, Renmin University of China, Beijing, China
| | - Xi Zheng
- School of Mathematical Sciences, South China Normal University, Guangzhou, China
| | - Hongchu Wang
- School of Mathematical Sciences, South China Normal University, Guangzhou, China
| | - Gang Song
- Southwest University, Chongqing, China
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Yang J, Zheng X, Wang Y, Wang H, Song G. Age Disparities in the Association Between Leisure-Time Physical Activity and Depression Among American Adults. J Clin Psychol 2025. [PMID: 40253596 DOI: 10.1002/jclp.23804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 02/21/2025] [Accepted: 04/10/2025] [Indexed: 04/22/2025]
Abstract
BACKGROUND This study aims to investigate the association between leisure-time physical activity (LTPA), age, and depressive symptoms. METHODS We included and analyzed data from 18,052 participants (age ≥ 20 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) (2007-2014). Multivariable logistic regression was employed to assess the independent associations between physical activity and household income with depressive symptoms. Restricted cubic spline plots were utilized to analyze the non-linear relationship between LTPA and depression. RESULTS Among the 18,052 participants, 1,676 (9.28%) were defined as having depressive symptoms. We found: 1. Age exhibits a non-linear relationship with depression, with a turning point around 40 years. 2. Compared to those with no LTPA, individuals with higher levels of LTPA (Q3) in both younger and older age groups experienced the lowest risk of depression, with risk reductions of 53% (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.33-0.67) and 74% (OR 0.26, 95% CI 0.14-0.50), respectively. Conversely, in the middle-aged group, those with the highest level of LTPA (Q4) experienced the greatest reduction in depression risk, by 67% (OR 0.33, 95% CI 0.21-0.53). 3. A U-shaped relationship between LTPA and depression risk was observed in younger and older age groups. CONCLUSION The risk of depression peaks around the age of 40 in adults. For middle-aged individuals, greater engagement in LTPA is associated with reduced depression risk. Conversely, higher levels of LTPA in younger and older adults may not confer additional protective effects.
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Affiliation(s)
| | - Xi Zheng
- South China Normal University, Guangzhou, China
| | - Yi Wang
- Department of Physical Education, Renmin University of China, Beijing, China
| | | | - Gang Song
- Southwest University, Chongqing, China
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Pinheiro MLSP, Tonaco LAB, Felisbino-Mendes MS, Velásquez-Meléndez JG, Malta DC, Moreira AD. Association between cardiovascular health and self-reported depression: 2019 National Health Survey. CIENCIA & SAUDE COLETIVA 2025; 30:e08822023. [PMID: 40298714 DOI: 10.1590/1413-81232025304.08822023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/10/2024] [Indexed: 04/30/2025] Open
Abstract
The aim is to analyze the association between the ideal cardiovascular health score and the self-reported diagnosis of depression in Brazilian adults. Cross-sectional study, with 57,898 Brazilian adults from the 2019 National Health Survey. Presence of self-reported depression. Exposures: behavioral scores (BMI, smoking, diet, physical activity, ideal if ≥3 ideal factors), biological (smoking, dyslipidemia, hypertension and diabetes, ideal if ≥3 ideal factors) and cardiovascular health (all factors, ideal if ≥4 ideal factors), based on the score proposed by the American Heart Association. They were categorized as poor/intermediate or ideal. Associations were tested using logistic regression models adjusted for sociodemographic characteristics. The prevalence of depression was 11.1%. All scores classified as ideal were inversely associated with depression after adjustments for sociodemographic variables (Ideal behavioral score: OR: 0.58 [95%CI: 0.48-0.70], ideal biological score: OR: 0.48 [95%CI: 0.43-0.53] and ideal cardiovascular health: OR: 0.53 [95%CI: 0.48-0.59]). The ideal cardiovascular health score was inversely associated with the self-reported diagnosis of depression among Brazilian adults.
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Affiliation(s)
- Maria Luiza Sady Prates Pinheiro
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG). Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Luís Antônio Batista Tonaco
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, UFMG. Belo Horizonte MG Brasil
| | | | | | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, UFMG. Belo Horizonte MG Brasil
| | - Alexandra Dias Moreira
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, UFMG. Belo Horizonte MG Brasil
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Queiroga LDL, Kaufmann OG, Ritti-Dias RM, Minanni CA, Pitta RM, Wolosker N. Are changes in physical activity associated with depression? A follow-up study of 1,950 individuals. EINSTEIN-SAO PAULO 2025; 23:eAO1128. [PMID: 40136148 PMCID: PMC11991741 DOI: 10.31744/einstein_journal/2025ao1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 10/02/2024] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND This study evaluated the association between changes in physical activity and depression among 1,950 Brazilians. Individuals who increased their physical activity and those who decreased it were not associated with reduced depression. Conversely, being consistently active was identified as an independent and significant protective factor against depression in this population. ■ Persistently active individuals have strong independent protective factors against depression. ■ BMI (kg/m) is an independent risk factor for depression. ■ Individuals with depression at follow-up were older than those without depression. ■ Perceived stress is a strong independent risk factor for depression. OBJECTIVE To evaluate the association between changes in physical activity and depression in 1,950 Brazilians. METHODS This follow-up study included 1,950 Brazilians, aged ≥18 years, of both sexes, who participated in a health screening initiative between 2008 and 2022. Physical activity levels were evaluated using the International Physical Activity Questionnaire at baseline and follow-up, and groups related to changes in physical activity were created. Depression was assessed using the Beck Depression Inventory. Clinical data and behavioral profiles were also analyzed. Comparative and logistic regression models were used. RESULTS The multivariate analysis demonstrated that persistently active individuals had reduced depression (odds ratio [OR], 0.70, 95%CI= 0.55-0.91, p=0.006). Individuals who became active and those who became less active were not associated with a reduction in depression (respectively, OR= 0.81, 95%CI= 0.63-1.05, p=0.109 and OR= 1.11, 95%CI= 0.82-1.51, p=0.481). CONCLUSION Persistent activity was an independent, strong protective factor against depression in 1,950 Brazilians. Furthermore, becoming active or less active was not associated with depression in the same population.
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Affiliation(s)
- Luana de Lima Queiroga
- Programa de Pós-Graduação em Ciências da SaúdeFaculdade Israelita de Ciências de Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Saúde, Faculdade Israelita de Ciências de Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Oskar Grau Kaufmann
- Programa de Pós-Graduação em Ciências da SaúdeFaculdade Israelita de Ciências de Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Saúde, Faculdade Israelita de Ciências de Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Raphael Mendes Ritti-Dias
- Programa de Pós-Graduação em Ciências da ReabilitaçãoUniversidade Nove JulhoSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Nove Julho, São Paulo, SP, Brazil.
| | - Carlos André Minanni
- Programa de Pós-Graduação em Ciências da SaúdeFaculdade Israelita de Ciências de Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Saúde, Faculdade Israelita de Ciências de Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rafael Mathias Pitta
- Programa de Pós-Graduação em Ciências da SaúdeFaculdade Israelita de Ciências de Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Saúde, Faculdade Israelita de Ciências de Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Wolosker
- Programa de Pós-Graduação em Ciências da SaúdeFaculdade Israelita de Ciências de Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Programa de Pós-Graduação em Ciências da Saúde, Faculdade Israelita de Ciências de Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Guo JW, Ning H, Lloyd‐Jones DM. Cardiovascular Health Status in US Adults With Chronic Diseases: National Health and Nutrition Examination Survey (NHANES), 2013-2018. J Am Heart Assoc 2025; 14:e034388. [PMID: 39719405 PMCID: PMC12054493 DOI: 10.1161/jaha.124.034388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 09/16/2024] [Indexed: 12/26/2024]
Abstract
BACKGROUND Cardiovascular health (CVH) assessment may have important benefits for adults with chronic diseases to prevent incident cardiovascular disease and additional chronic conditions. Few studies have compared CVH in adults with chronic diseases and healthy adults without chronic disease using the American Heart Association's (AHA's) Life's Essential 8 (LE8) metrics. METHODS AND RESULTS We used National Health and Nutrition Examination Survey data from 2013 to 2018 to identify the presence of 16 chronic diseases by participant self-report of diagnosis. We included adults aged 20 to 79 years. CVH was defined by AHA's LE8 metrics. Overall mean LE8 (range 0-100, higher = better CVH) and individual LE8 metric scores were calculated according to disease status for all participants and stratified by self-identified sex, race, and ethnicity. There were 12 296 adults (51% women; mean age, 46 years) representing >186 million noninstitutionalized US adults. Significantly, and often substantially, lower CVH scores were noted for adults with chronic disease (14 of 16 diseases studied) versus unaffected adults, including all subtypes of cardiovascular disease, lung diseases, chronic kidney disease, liver conditions, cancer, arthritis, cognitive decline, and depression. For example, mean overall LE8 score was 14.0 points lower in those with versus without chronic obstructive pulmonary disease (51.0 versus 65.0, P<0.0001). Men and Black adults consistently had lower LE8 scores. CONCLUSIONS CVH is significantly poorer in adults with many chronic diseases compared with unaffected adults. These data suggest the utility of the LE8 score to identify groups for targeted optimization of CVH to enhance primary and secondary prevention efforts for cardiovascular disease and potentially for concomitant chronic diseases of aging.
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Affiliation(s)
- James W. Guo
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Hongyan Ning
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Donald M. Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
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Zhang Y, Wang Y, Fan X, He Y, Li R, Cheng X, Jin L. American Heart Association's new "Life's Essential 8" score and depression in adults with chronic diseases and comorbidity: NHANES, 2007 through 2018. J Psychiatr Res 2025; 181:188-196. [PMID: 39616865 DOI: 10.1016/j.jpsychires.2024.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/25/2024] [Accepted: 11/22/2024] [Indexed: 01/22/2025]
Abstract
OBJECTIVE The coexistence of depression and chronic diseases might lead to greater disability and increased mortality, and the American Heart Association (AHA) recently proposed Life's Essential 8 (LE8) score to quantify cardiovascular health (CVH). The study aimed to examine the association between LE8 and depression among adults with chronic diseases and comorbidity. METHODS 14,029 adults with chronic diseases from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included in the study. Overall LE8 and subscale scores were categorized into low, moderate, and high groups. Multivariate logistic regressions were applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between LE8 and depression among adults with various chronic diseases and comorbidity. RESULTS After adjusting for all covariates, compared to low CVH, high CVH was associated with a significantly lower presence of depressive symptoms among adults with diabetes [OR (95% CI), 0.25 (0.11, 0.58)], hypertension [0.27 (0.20, 0.36)], coronary heart disease [0.16 (0.07, 0.36)], stroke [0.29 (0.11, 0.76)], hyperlipidemia [0.24 (0.20, 0.30)], at least one chronic comorbidity [0.25 (0.21, 0.30)], any single chronic condition [0.28 (0.21, 0.38)], and comorbidities [0.27 (0.19, 0.38)]. Similarly, moderate CVH was also associated with a lower presence of depressive symptoms among adults with various chronic diseases and comorbidities. Dose-response relationships were found, revealing that the ORs for depressive symptoms increased with the decrease of the LE8 score and subscale scores among adults with chronic diseases and comorbidities. CONCLUSION The prevalence of depression increases with decreasing levels of the LE8 and subscale scores among adults with various chronic diseases and comorbidities in the United States.
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Affiliation(s)
- Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Xiaoting Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Runhong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Xiaowei Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
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Zhao S, Tang Y, Li Y, Shen H, Liu A. Associations between Life's Essential 8 and depression among US adults. Psychiatry Res 2024; 338:115986. [PMID: 38850892 DOI: 10.1016/j.psychres.2024.115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/26/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
Few studies have examined the association of Life's Essential 8 (LE8) with depression among US adults. This is a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2020. LE8 score was measured as the mean score of eight metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid, blood glucose, and blood pressure). CVH was categorized into low, moderate, and high according to tertiles of LE8 score. Depression was defined based on the 9-Item Patient Health Questionnaire (PHQ-9). Weighted logistic regressions were conducted to assess the associations of depression with CVH. Compared with participants with low CVH, the fully adjusted ORs of depression were 0.45 (0.37, 0.55) in the moderate CVH and 0.21 (0.15, 0.30) in the high CVH participants, respectively. The results remained robust in subgroup and sensitivity analyses. All eight LE8 metrics were negatively associated with depression, while nicotine exposure and sleep health were identified as two major metrics contributing to the association. Better CVH evaluated by LE8 was associated with decreased depression prevalence among US adults. Adherence to a higher CVH score, especially targeting smoking cessation and proper sleep duration, might be beneficial for prevention of depression.
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Affiliation(s)
- Songfeng Zhao
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Hunan, China
| | - Ying Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yifan Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongxian Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Aihua Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Hunan, China; Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Huang X, Zhang J, Liang J, Duan Y, Xie W, Zheng F. Association of Cardiovascular Health With Risk of Incident Depression and Anxiety. Am J Geriatr Psychiatry 2024; 32:539-549. [PMID: 37968161 DOI: 10.1016/j.jagp.2023.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To investigate the association between cardiovascular health (CVH), defined by the American Heart Association's Life's Essential 8 (LE8) score, and incident depression and anxiety. DESIGN A prospective cohort study using data from UK Biobank. SETTING Participants were enrolled from March 2006 to October 2010. PARTICIPANTS Participants without cardiovascular diseases and common mental disorders at baseline and having complete data on metrics of LE8 were included. MEASUREMENTS CVH was assessed by LE8 score including eight components. The overall CVH was categorized as low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80). RESULTS We included 115,855 participants (mean age: 55.7 years; female: 52.6%). During a median follow-up of 12.4 years, 3,194 (2.8%) and 4,005 (3.5%) participants had incident depression and anxiety, respectively. Compared with participants having low CVH, those having moderate and high CVH had 37% (HR = 0.63, 95% CI: 0.57-0.70) and 52% (HR = 0.48, 95% CI: 0.41-0.55) lower risk of incident depression. Similarly, moderate and high CVH were related to a lower risk of incident anxiety (HR = 0.81, 95% CI: 0.73-0.89 and HR = 0.68, 95% CI: 0.60-0.78). Restricted cubic spline showed that LE8 score was inversely related to incident depression and anxiety in a linear manner, and the risk of incident depression and anxiety decreased by 17% (HR = 0.83, 95% CI: 0.80-0.85) and 10% (HR = 0.90, 95% CI: 0.88-0.92) for 10-point increment in LE8 score, respectively. CONCLUSIONS Higher CVH, evaluated by LE8 score, is strongly associated with a lower risk of incident depression and anxiety, suggesting the significance of optimizing CVH by adopting LE8.
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Affiliation(s)
- Xinghe Huang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyu Zhang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liang
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine (YD), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute (WX), Peking University First Hospital, Beijing, China
| | - Fanfan Zheng
- School of Nursing (XH, JZ, JL, FZ), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Li L, Dai F. Comparison of the associations between Life's Essential 8 and Life's Simple 7 with depression, as well as the mediating role of oxidative stress factors and inflammation: NHANES 2005-2018. J Affect Disord 2024; 351:31-39. [PMID: 38280569 DOI: 10.1016/j.jad.2024.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cardiovascular health (CVH) is closely associated with depression. However, Life's Essential 8 (LE8), a novel CVH measure, has not yet been clearly linked to depression. This study aims to explore the association between LE8 and depression, compare its advantages over Life's Simple 7 (LS7), and investigate the mediating effects of oxidative stress and inflammation. METHODS This study investigated cross-sectional data of adults aged 20 and above from National Health and Nutrition Examination Survey (NHANES) 2005 to 2018. The LE8 score (ranging from 0 to 100) was derived from the American Heart Association's definition, based on the unweighted average of 8 metrics, classified as low cardiovascular health (CVH) (0-49), moderate CVH (50-79), and high CVH (80-100). Similar to LE8, LS7 scores were categorized into inadequate (0-7), average (8-10), or optimal (11-14) after calculating the unweighted mean of each component. Depression was diagnosed using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 defining depression. Adjusted for sociodemographic factors and other risk factors for depression, weighted logistic regression and restricted cubic spline analysis were used to explore the correlation. Receiver operating characteristic (ROC) curves were used to study the associations between CVH scores and depression. Subsequently, subgroup analysis and sensitivity analysis were conducted, followed by an exploration of the mechanisms involved. RESULTS A total of 7 cycles from 2005 to 2018 contained complete data. Weighted logistic regression showed that both LS7 and LE8 were significantly associated with depression. Specifically, for LE8, after adjustment, the risk of depression decreased by 52 % for moderate CVH compared to low CVH (OR: 0.48, 95 % CI: 0.41-0.57, P < 0.0001), while the risk decreased by 80 % for high CVH (OR: 0.20, 95 % CI: 0.15-0.26, P < 0.0001, Ptrend < 0.0001). For LS7, after adjustment, compared with inadequate CVH, the risk of depression decreased by 49 % for average CVH (OR: 0.51, 95 % CI: 0.34-0.78, P = 0.002), and by 55 % for optimal CVH (OR: 0.45, 95 % CI: 0.27-0.74, P = 0.002, Ptrend < 0.0001). Area under ROC curves for predicting depression were 0.672 (95 % CI, 0.66-0.684; P < 0.001) and 0.605 (95 % CI, 0.59-0.619; P < 0.001) for LE8 and LS7 (PDeLong < 0.001), respectively. Sensitivity analysis demonstrated the robustness of the association. GGT and WBC jointly mediated 9.62 % of this association (all P < 0.001). LIMITATIONS The cross-sectional study cannot infer causality. CONCLUSIONS The association between Life's Essential 8 and depression was stronger and more practical. Oxidative stress and inflammation mediate this association. Individuals with extremely poor cardiovascular health have a 7-fold increased risk of depression, highlighting the necessity of maintaining at least moderate cardiovascular health.
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Affiliation(s)
- Laifu Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Key Laboratory of Gastrointestinal Motility Disorders, Xi'an, China
| | - Fei Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Key Laboratory of Gastrointestinal Motility Disorders, Xi'an, China.
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11
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Joseph JJ, Nolan TS, Brock G, Williams A, Zhao S, McKoy A, Kluwe B, Metlock F, Campanelli K, Odei JB, Khumalo MT, Lavender D, Gregory J, Gray DM. Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program. BMC Psychiatry 2024; 24:34. [PMID: 38195473 PMCID: PMC10775551 DOI: 10.1186/s12888-023-05064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Poor mental health is a leading cause of morbidity and mortality among Black men in the United States. Efforts to improve mental health among Black men have been hampered by a lack of access and utilization of mental health services. Physical activity and social networks have been shown to improve mental health. Thus, we examined the effect of a community team-based physical activity, health education and social needs intervention among Black men on mental health over 24 weeks. METHODS Black adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Measures of mental health including the Center for Epidemiological Studies Depression Scale (CES-D), Patient Health Questionnaire 2-question depression screener (PHQ-2), and Perceived Stress Scale-10 (PSS-10) were completed at baseline, 12 and 24 weeks. The change in mental health scores from baseline to 12 and 24 weeks were evaluated using linear mixed-effects models adjusting for age, education, and income. The change in cardiovascular health scores, defined as objective metrics of LS7 (LS5 [blood pressure, total cholesterol, fasting glucose, body mass index and smoking]), by baseline mental health were evaluated using linear mixed-effects models with an interaction term (time*baseline mental health variable) and a random intercept for each participant. RESULTS Among 71 Black men (mean age 51, 85% employed) at 24 weeks, CES-D scores decreased from 10.54 to 7.90 (-2.64, 95%CI:-4.74, -0.55), PHQ-2 decreased from 1.04 to 0.63 (-0.41, 95%CI: -0.75, -0.07), and PSS-10 decreased from 14.62 to 12.91 (-1.71, 95%CI: -3.53, 0.12). A 1-unit higher CES-D at baseline was associated with less improvement in LS5 scores by -0.04 (95%CI: -0.076, -0.005) and - 0.032 (95%CI:-0.067, 0.003) units at week 12 and 24, respectively, with similar findings for PSS. CONCLUSIONS The Black Impact community-based lifestyle program has the potential to reduce depressive symptoms and stress in Black men. There is a dire need for larger, randomized studies to test the impact of Black Impact on mental health in Black men to advance health equity. TRIAL REGISTRATION Retrospectively Registered, ClinicalTrials.gov Identifier: NCT04787978.
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Affiliation(s)
- Joshua J Joseph
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA.
| | - Timiya S Nolan
- The Ohio State University College of Nursing, Columbus, OH, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Guy Brock
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Amaris Williams
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Alicia McKoy
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Bjorn Kluwe
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Faith Metlock
- The Ohio State University College of Nursing, Columbus, OH, USA
| | | | - James B Odei
- The Ohio State University College of Public Health, Columbus, OH, USA
| | | | - Dana Lavender
- The African American Male Wellness Agency, Columbus, OH, USA
| | - John Gregory
- The African American Male Wellness Agency, Columbus, OH, USA
- National Center for Urban Solutions, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
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12
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Carroll AJ, Huffman MD, Wileyto EP, Khan SS, Fox E, Smith JD, Bauer AM, Leone FT, Schnoll RA, Hitsman B. Change in cardiovascular health among adults with current or past major depressive disorder enrolled in intensive smoking cessation treatment. J Affect Disord 2023; 333:527-534. [PMID: 37119868 PMCID: PMC10236931 DOI: 10.1016/j.jad.2023.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Elevated depressive symptoms and cigarette smoking are independently associated with poorer cardiovascular health (CVH), but it is unknown whether their treatment can synergistically improve CVH. We sought to characterize CVH of adults with comorbid depression and smoking and examine changes in CVH associated with changes in smoking and depression. METHODS Participants (N = 300, 55 % women) were adult smokers (≥ 1 cigarette/day) with lifetime major depressive disorder enrolled in a 12-week intervention trial targeting depression and smoking. Multiple linear regression examined prospective associations between changes in depression (Beck Depression Inventory-II), smoking (past 24-hour cigarettes or smoking abstinence), and modified CVH score (per American Heart Association, excluding smoking: diet, physical activity, body mass index, blood glucose, cholesterol, blood pressure). RESULTS Baseline mean CVH score was 5.87/12 points (SD = 2.13). No participants met "ideal" on all CVH components (blood glucose: 48 %, cholesterol: 46 %, physical activity: 38 %, body mass index: 24 %, blood pressure: 22 %, diet: 3 %). CVH scores did not change from baseline to end-of-treatment (M = 0.18 points, SD = 1.36, p = .177), nor did change in depression × smoking predict change in CVH (p = .978). However, greater reductions in depression were significantly associated with greater improvements in CVH (β = -0.04, SE = 0.01, p = .015). LIMITATIONS This study was limited by a short follow-up period, missing blood glucose and cholesterol data, and treatment-seeking smokers. CONCLUSIONS Adults with comorbid depression and smoking had poor CVH. Although integrated treatment for depression and smoking improved both conditions, only reductions in depression were associated with improvements in CVH. These findings have implications for integrating psychosocial treatment into CVH promotion efforts. REGISTRATION NCT02378714 (clinicaltrials.gov).
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Affiliation(s)
- Allison J Carroll
- Departments of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Mark D Huffman
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America; The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Erica Fox
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States of America
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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van Sloten TT, Valentin E, Climie RE, Jouven X, Lemogne C, Goldberg M, Zins M, Empana JP. Association of Cardiovascular Health With Risk of Clinically Relevant Depressive Symptoms. JAMA Psychiatry 2023; 80:342-349. [PMID: 36790776 PMCID: PMC9932942 DOI: 10.1001/jamapsychiatry.2022.5056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Importance Cardiovascular health may be used for prevention of depressive symptoms. However, data on the association of cardiovascular health across midlife with depressive symptoms are lacking. Objective To evaluate whether better baseline cardiovascular health and improvement of cardiovascular health over time are associated with a lower risk of both incident depressive symptoms and unfavorable trajectories of depressive symptoms. Design, Setting, and Participants Participants without depressive symptoms were included from a prospective community-based cohort in France (GAZEL cohort). Cardiovascular health examinations occurred in 1990 and 1997 and assessment of depressive symptoms in 1997 and every 3 years thereafter until 2015. Data were analyzed from January to October 2022. Exposures Number of cardiovascular health metrics (smoking, body mass index, physical activity, diet, blood pressure, glucose, and cholesterol) at an intermediate or ideal level in 1997 (range, 0-7) and 7-year change in cardiovascular health between 1990 and 1997. Main Outcomes and Measures Primary outcome was incident depressive symptoms (20-item Center for Epidemiologic Studies-Depression Scale [CES-D] score of 17 or greater in men or 23 or greater in women); secondary outcome was trajectories of depressive symptoms scores. Trajectories included consistently low scores, moderately elevated scores, low starting then increasing scores, moderately high starting, increasing, then remitting scores, and moderately high starting then increasing scores. Results Of 6980 included patients, 1671 (23.9%) were women, and the mean (SD) age was 53.3 (3.5) years. During a follow-up spanning 19 years after 1997, 1858 individuals (26.5%) had incident depressive symptoms. Higher baseline cardiovascular health in 1997 and improvement in cardiovascular health over 7 years were each associated with lower risk of depressive symptoms (odds ratio [OR] per additional metric at intermediate or ideal level at baseline, 0.87; 95% CI, 0.84-0.91; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.91; 95% CI, 0.86-0.96). Also, better cardiovascular health was associated with lower risk of unfavorable depressive symptoms trajectories. Compared with the consistently low score trajectory, the lowest risks were observed for the low starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.70; 95% CI, 0.64-0.76; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.73; 95% CI, 0.68-0.79) and the moderately high starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.71; 95% CI, 0.64-0.79; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77). Conclusions and Relevance In this prospective community-based cohort study of adults, higher cardiovascular health was associated with a lower risk of depressive symptoms over time. Elucidating which set of cardiovascular factors may affect depression risk could be important for prevention.
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Affiliation(s)
- Thomas T. van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eugénie Valentin
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
| | - Rachel E. Climie
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
- Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
| | - Xavier Jouven
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
| | - Cedric Lemogne
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, Paris, France
- Service de Psychiatrie de l’Adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Marcel Goldberg
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Marie Zins
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, Paris, France
| | - Jean-Philippe Empana
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
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Associations between life's simple 7 and incident depression among adults aged 50 years and older: A 15-year cohort study. Psychiatry Res 2023; 320:115046. [PMID: 36599180 DOI: 10.1016/j.psychres.2022.115046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
This study aimed to examine association of Life's Simple 7 (LS7), an estimation of cardiovascular health status, with depression and the modification by genetic risk. Longitudinal analysis was conducted on participants aged 50 years and older in the English Longitudinal Study of Ageing (ELSA) (Waves 2 to 9). Cardiovascular health status was assessed by the LS7 which contains four health behaviors and three biological metrics. Depression was measured by the Center for Epidemiological Studies-Depression scale (CES-D). Associations of LS7 and its components with incident depression were estimated with Cox regression model adjusting for multiple covariates. Among 3231 participants, higher LS7 scores were associated with decreased risks of incident depression. Improvements in healthy behaviors (BMI, smoking, and physical activity) and blood glucose status presented inverse associations with depression. However, increased risk of depression was found among participants who had a better control of total cholesterol. In addition, the LS7-depression association was stronger among participants with high genetic risk compared to those with low genetic risk. Our findings indicated that favorable cardiovascular health, especially healthy behaviors, were associated with lower risk of depression. Higher LS7 scores were inversely associated with depression, especially among participants with high genetic risk.
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15
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Patterson SL, Marcus M, Goetz M, Vaccarino V, Gooding HC. Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults. J Am Heart Assoc 2022; 11:e027610. [PMID: 36533593 PMCID: PMC9798786 DOI: 10.1161/jaha.122.027610] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
Background Cardiovascular health (CVH) declines in young adulthood, and mood disorders commonly emerge during this life stage. This study examined the association between depression, anxiety, and CVH metrics among young adults. Methods and Results We conducted a cross-sectional analysis of participants aged 18 to 34 years who completed the Emory Healthy Aging Study Health History Questionnaire (n=875). We classified participants as having poor, intermediate, or ideal levels of the 8 CVH metrics using definitions set forth by the American Heart Association with adaptions when necessary. We defined depression and anxiety as absent, mild, or moderate to severe using standard cutoffs for Patient Health Questionnaire and General Anxiety Disorder scales. We used multivariable regression to examine the association between depression and anxiety and CVH, adjusting for age, sex, race and ethnicity, income, and education. The mean participant age was 28.3 years, and the majority identified as women (724; 82.7%); 129 (14.7%) participants had moderate to severe anxiety, and 128 (14.6%) participants had moderate to severe depression. Compared with those without anxiety, participants with moderate to severe anxiety were less likely to meet ideal levels of physical activity (adjusted prevalence ratio [aPR], 0.60 [95% CI, 0.44-0.82]), smoking (aPR, 0.90 [95% CI, 0.82-0.99]), and body mass index (aPR, 0.79 [95% CI, 0.66-0.95]). Participants with moderate to severe depression were less likely than those without depression to meet ideal levels of physical activity (aPR, 0.48 [95% CI, 0.34-0.69]), body mass index (aPR, 0.75 [95% CI, 0.61-0.91]), sleep (aPR, 0.79 [95% CI, 0.66-0.94]), and blood pressure (aPR, 0.92 [95% CI, 0.86-0.99]). Conclusions Anxiety and depression are associated with less ideal CVH in young adults. Interventions targeting CVH behaviors such as physical activity, diet, and sleep may improve both mood and CVH.
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Affiliation(s)
- Sierra L. Patterson
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNC
| | - Michele Marcus
- Department of EpidemiologyRollins School of Public HealthAtlantaGA
- Department of Environmental HealthRollins School of Public HealthAtlantaGA
| | | | - Viola Vaccarino
- Department of EpidemiologyRollins School of Public HealthAtlantaGA
| | - Holly C. Gooding
- Department of PediatricsEmory University School of MedicineAtlantaGAUnited States
- Children’s Healthcare of AtlantaAtlantaGA
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Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, Kelly P, Khan S, Utukuri M, Laird Y, Mok A, Smith A, Tainio M, Brage S, Woodcock J. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:550-559. [PMID: 35416941 PMCID: PMC9008579 DOI: 10.1001/jamapsychiatry.2022.0609] [Citation(s) in RCA: 535] [Impact Index Per Article: 178.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
Importance Depression is the leading cause of mental health-related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain. Objective To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults. Data Sources PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020. Study Selection We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up. Data Extraction and Synthesis Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood. Main Outcomes and Measures The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument. Results Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P < .001). Relative to adults not reporting any activity, those accumulating half the recommended volume of physical activity (4.4 marginal metabolic equivalent task hours per week [mMET-h/wk]) had 18% (95% CI, 13%-23%) lower risk of depression. Adults accumulating the recommended volume of 8.8 mMET hours per week had 25% (95% CI, 18%-32%) lower risk with diminishing potential benefits and higher uncertainty observed beyond that exposure level. There were diminishing additional potential benefits and greater uncertainty at higher volumes of physical activity. Based on an estimate of exposure prevalences among included cohorts, if less active adults had achieved the current physical activity recommendations, 11.5% (95% CI, 7.7%-15.4%) of depression cases could have been prevented. Conclusions and Relevance This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.
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Affiliation(s)
- Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Felipe Barreto Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute of Sport Physical Education and Health Science, University of Edinburgh, Edinburgh, Scotland
| | - Saad Khan
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Treatment Centre, Cambridge Biomedical Campus, Cambridge, England
| | - Mrudula Utukuri
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Treatment Centre, Cambridge Biomedical Campus, Cambridge, England
| | - Yvonne Laird
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Andrea Smith
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Marko Tainio
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Sustainable Urban Programme, The Finnish Environment Institute, Helsinki, Finland
- Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
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Nmezi NA, Turkson-Ocran RA, Tucker CM, Commodore-Mensah Y. The Associations between Depression, Acculturation, and Cardiovascular Health among African Immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6658. [PMID: 35682247 PMCID: PMC9180644 DOI: 10.3390/ijerph19116658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death both globally and in the United States (U.S.). Racial health disparities in cardiovascular health (CVH) persist with non-Hispanic Black adults having a higher burden of CVD morbidity and mortality compared to other racial groups. African immigrants represent an increasingly growing sub-population of the overall U.S. non-Hispanic Black adult population, however little is known about how specific psychological and social factors (i.e., depression and acculturation) influence the CVH of U.S. African immigrants. We sought to examine the association between severity of depression symptomology and CVH among African immigrants, and whether acculturation moderated the relationship between severity of depression symptoms and CVH. Study participants were those in the African Immigrant Health Study conducted in the Baltimore-Washington D.C. area. Severity of depression symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8). CVH was assessed using the American Heart Association Life's Simple 7 metrics and categorized as poor, intermediate, and ideal CVH. Acculturation measured as length of stay and acculturation strategy was examined as a moderator variable. Multivariable logistic regression was used to examine the association between depression and CVH and the moderating effect of acculturation adjusting for known confounders. In total 317 African immigrants participated in the study. The mean (±SD) age of study participants was 46.9 (±11.1) and a majority (60%) identified as female. Overall, 8.8% of study participants endorsed moderate-to-severe symptoms of depression. African immigrants endorsing moderate-to-severe levels of depression were less likely to have ideal CVH compared to those with minimal-to-mild symptoms of depression (Adjusted Odds Ratio [AOR]: 0.42, 95% CI: 0.17-0.99). Acculturation measured either as length of stay or acculturation strategy did not moderate the relationship between depression and CVH among study participants. Study participants exhibited elevated levels of symptoms of depression. Greater severity of depression symptoms was associated with worse CVH. Efforts to treat and prevent CVD among African immigrants should also include a focus on addressing symptoms of depression within this population.
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Affiliation(s)
- Nwakaego A. Nmezi
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ruth-Alma Turkson-Ocran
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Carolyn M. Tucker
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA;
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 3170] [Impact Index Per Article: 1056.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Tabb LP, Diez Roux AV, Barber S, Judd S, Lovasi G, Lawson A, McClure LA. Spatially varying racial inequities in cardiovascular health and the contribution of individual- and neighborhood-level characteristics across the United States: The REasons for geographic and racial differences in stroke (REGARDS) study. Spat Spatiotemporal Epidemiol 2022; 40:100473. [PMID: 35120683 PMCID: PMC8867394 DOI: 10.1016/j.sste.2021.100473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Black-White inequities in cardiovascular health (CVH) pose a significant public health challenge, with these disparities also varying geographically across the US. There remains limited evidence of the impact of social determinants of health on these inequities. Using a national population-based cohort from the REasons for Geographic and Racial Differences in Stroke study, we assessed the spatial heterogeneity in Black-White differences in CVH and determined the extent to which individual- and neighborhood-level characteristics explain these inequities. We utilized a Bayesian hierarchical statistical framework to fit spatially varying coefficient models. Results showed overall and spatially varying inequities, where Black participants had significantly poorer CVH. The maps of the state level random effects also highlighted how inequities vary. The evidence produced in this study further highlights the importance of multilevel approaches - at the individual- and neighborhood-levels - that need to be in place to address these geographic and racial differences in CVH.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA,Corresponding Author:
| | - Ana V. Diez Roux
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Sharrelle Barber
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Suzanne Judd
- University of Alabama at Birmingham, School of Public Health, Department of Biostatistics
| | - Gina Lovasi
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Andrew Lawson
- Medical University of South Carolina, College of Medicine
| | - Leslie A. McClure
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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20
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Ogunmoroti O, Osibogun O, Spatz ES, Okunrintemi V, Mathews L, Ndumele CE, Michos ED. A systematic review of the bidirectional relationship between depressive symptoms and cardiovascular health. Prev Med 2022; 154:106891. [PMID: 34800472 DOI: 10.1016/j.ypmed.2021.106891] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 12/25/2022]
Abstract
Depression is a mental health disorder associated with a 2-fold increase in cardiovascular disease risk. However, the association between depression and cardiovascular health (CVH), as reflected by the American Heart Association's (AHA) CVH metrics, is incompletely understood. We aimed to systematically review the current evidence to understand and clarify whether a bidirectional relationship exists between depressive symptoms and CVH. We conducted a systematic review by searching EMBASE, Google Scholar, PubMed and Web of Science from inception to May 2021. MeSH terms and keywords were used to identify studies with information on depressive symptoms and CVH. Among 132 articles screened, 11 studies were included with 101,825 participants. Eight studies were cross-sectional while 3 studies used a prospective cohort design. Five studies found an association between participants with unfavorable CVH and depressive symptoms. Six studies found an association between participants with depressive symptoms and unfavorable CVH. In summary, we found a bidirectional relationship may exist between depressive symptoms and CVH. Further research is required to quantify the risk and identify the biological mechanisms underlying the association between depressive symptoms and unfavorable CVH so adequate screening and interventions can be directed towards people with depressive symptoms or unfavorable CVH.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Liu M, Kou F, Yang S, Wang S, He Y, Zhang W. Ideal Cardiovascular Health in the Oldest-Old and Centenarians and Its Association With Disability and Health-Related Quality of Life. Front Cardiovasc Med 2021; 8:603877. [PMID: 34490360 PMCID: PMC8417589 DOI: 10.3389/fcvm.2021.603877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to investigate the distribution of ideal cardiovascular health (ICH) indicators among the oldest-old and centenarians and explore their relationships with disability and health-related quality of life of this population. Methods: One thousand two centenarians from China Hainan Centenarian Cohort Study and 798 oldest-old from the China Hainan Oldest-old Cohort study were the target subjects in this analysis. ICH status, disability, and health-related quality of life of study subjects were assessed. Findings: The median value of ICH indicators among centenarians and the oldest-old is 4 (4–5) and 3 (3–5), respectively. The ICH indicators with the highest percentage of ideal level/status are fasting plasm glucose (FPG) (90.2% of study subjects are at the ideal level), BMI (89.8% of study subjects are at the ideal level), and smoking (89.4% of study subjects are at the ideal status). The disability rates of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) decrease with the increasing number of ICH indicators. The EQ VAS and EQ-5D score show an increasing trend along with the increasing number of ICH indicators (p < 0.05). After adjusting related covariates, the risk of disability and lower health-related quality of life decreased gradually as the number of ICH metrics increased (p < 0.05). Interpretation: The ICH metrics of centenarians and oldest-old were at a relatively good level, and there was a strong and independent relationship between the number of ICH indicators and disability as well as the lower health-related quality of life.
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Affiliation(s)
- Miao Liu
- Department of Statistics and Epidemiology, Graduate School of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fuyin Kou
- Health Service Department, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shanshan Yang
- The 1st Medical Center, Department of Disease Prevention and Control, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shengshu Wang
- National Clinical Research Center for Geriatrics Diseases, Beijing Key Laboratory of Aging and Geriatrics, State Key Laboratory of Kidney Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yao He
- National Clinical Research Center for Geriatrics Diseases, Beijing Key Laboratory of Aging and Geriatrics, State Key Laboratory of Kidney Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wuping Zhang
- Foreign Language Department, Graduate School, Graduate School of Chinese People's Liberation Army General Hospital, Beijing, China
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22
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Michos ED, Khan SS. Further understanding of ideal cardiovascular health score metrics and cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:607-617. [PMID: 34053373 DOI: 10.1080/14779072.2021.1937127] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The American Heart Association (AHA) introduced the construct of 'cardiovascular health (CVH)', to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor. AREAS COVERED In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends. EXPERT OPINION Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.
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Affiliation(s)
- Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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23
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3535] [Impact Index Per Article: 883.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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24
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Bousquet-Santos K, Chen R, Kubzansky LD. A sad heart: Depression and favorable cardiovascular health in Brazil. Prev Med 2021; 142:106378. [PMID: 33346038 DOI: 10.1016/j.ypmed.2020.106378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Depression is associated with poor cardiovascular health (CVH) and increased risk of cardiovascular disease in high-income countries. However, it is unclear whether depression, particularly somatic depressive symptoms, may similarly contribute to poor CVH in a different socioeconomic context. Our aim was to investigate the association between depression and CVH in Brazil, a middle-income country. 49,658 participants (≥18 years) from the 2013 National Health Survey-Brazil. Favorable CVH was defined by meeting recommended levels on five CVH components (blood pressure, body mass index, diabetes or hypercholesterolemia status, smoking status). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; depressed if score ≥ 10). Two PHQ-9 sub-domain scores (somatic or cognitive symptoms) were also considered. Covariates included age, sex, race, income, education, region of residence, marital status, chronic diseases, diet and physical activity. Depression was associated with a 27% lower odds of having favorable CVH (OR 0.73; 95%CI 0.62-0.86), and the association was stronger among women (OR 0.72; 95%CI 0.60-0.86). Both somatic and cognitive depression symptoms were inversely associated with lower odds of having favorable CVH. In conclusion, depression is associated with lower odds of having favorable CVH in Brazil, and associations are evident across both somatic and cognitive components of depression. Moreover, the relationship was independent of socioeconomic factors, chronic diseases, and was not strongly explained by diet or physical activity. Overall, our findings suggest that the greater odds of having poor CVH among depressed individuals is not unique to high-income countries.
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Affiliation(s)
- Kelb Bousquet-Santos
- Department of Biological and Health Sciences, University of Brasilia, Campus Universitario - Centro Metropolitano, Ceilandia Campus. Brasilia, FD 72220-275, Brazil; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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25
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Tibuakuu M, Okunrintemi V, Savji N, Stone NJ, Virani SS, Blankstein R, Thamman R, Blumenthal RS, Michos ED. Nondietary Cardiovascular Health Metrics With Patient Experience and Loss of Productivity Among US Adults Without Cardiovascular Disease: The Medical Expenditure Panel Survey 2006 to 2015. J Am Heart Assoc 2020; 9:e016744. [PMID: 32998625 PMCID: PMC7792398 DOI: 10.1161/jaha.120.016744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The American Heart Association 2020 Impact Goals aimed to promote population health through emphasis on cardiovascular health (CVH). We examined the association between nondietary CVH metrics and patient‐reported outcomes among a nationally representative sample of US adults without cardiovascular disease. Methods and Results We included adults aged ≥18 years who participated in the Medical Expenditure Panel Survey between 2006 and 2015. CVH metrics were scored 1 point for each of the following: not smoking, being physically active, normal body mass index, no hypertension, no diabetes mellitus, and no dyslipidemia, or 0 points if otherwise. Diet was not assessed in Medical Expenditure Panel Survey. Patient‐reported outcomes were obtained by telephone survey and included questions pertaining to patient experience and health‐related quality of life. Regression models were used to compare patient‐reported outcomes based on CVH, adjusting for sociodemographic factors and comorbidities. There were 177 421 Medical Expenditure Panel Survey participants (mean age, 45 [17] years) representing ~187 million US adults without cardiovascular disease. About 12% (~21 million US adults) had poor CVH. Compared with individuals with optimal CVH, those with poor CVH had higher odds of reporting poor patient‐provider communication (odds ratio, 1.14; 95% CI, 1.05–1.24), poor healthcare satisfaction (odds ratio, 1.15; 95% CI, 1.08–1.22), poor perception of health (odds ratio, 5.89; 95% CI, 5.35–6.49), at least 2 disability days off work (odds ratio, 1.39; 95% CI, 1.30–1.48), and lower health‐related quality of life scores. Conclusions Among US adults without cardiovascular disease, meeting a lower number of ideal CVH metrics is associated with poor patient‐reported healthcare experience, poor perception of health, and lower health‐related quality of life. Preventive measures aimed at optimizing ideal CVH metrics may improve patient‐reported outcomes among this population.
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Affiliation(s)
- Martin Tibuakuu
- Department of Medicine St. Luke's Hospital Chesterfield MO.,The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | | | - Nazir Savji
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Neil J Stone
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Salim S Virani
- Section of Cardiology Michael E. DeBakey Veterans Affairs Medical Center Section of Cardiovascular Research Baylor College of Medicine Houston TX
| | - Ron Blankstein
- Division of Cardiology Brigham and Women's Hospital Boston MA
| | - Ritu Thamman
- Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
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26
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Tabb LP, McClure LA, Ortiz A, Melly S, Jones MR, Kershaw KN, Roux AVD. Assessing the spatial heterogeneity in black-white differences in optimal cardiovascular health and the impact of individual- and neighborhood-level risk factors: The Multi-Ethnic Study of Atherosclerosis (MESA). Spat Spatiotemporal Epidemiol 2020; 33:100332. [PMID: 32370943 PMCID: PMC7205896 DOI: 10.1016/j.sste.2020.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/08/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
Racial disparities in cardiovascular health (CVH) continue to remain a public health concern in the United States. We use unique population-based data from the Multi-Ethnic Study of Atherosclerosis cohort to explore the black-white differences in optimal CVH. Utilizing geographically weighted regression methods, we assess the spatial heterogeneity in black-white differences in optimal CVH and the impact of both individual- and neighborhood-level risk factors. We found evidence of significant spatial heterogeneity in black-white differences that varied within and between the five sites. Initial models showed decreased odds of optimal CVH for blacks that ranged from 60% to 70% reduced odds - with noticeable variation of these decreased odds within each site. Adjusting for risk factors resulted in reductions in the black-white differences in optimal CVH. Further understanding of the reasons for spatial heterogeneities in black-white differences in nationally representative cohorts may provide important clues regarding the drivers of these differences.
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Affiliation(s)
- Loni Philip Tabb
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Angel Ortiz
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - Steven Melly
- Urban Health Collaborative, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA.
| | - Miranda R Jones
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680N. Lake Shore Drive, Chicago, IL 60611, USA.
| | - Ana V Diez Roux
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
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27
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 5398] [Impact Index Per Article: 1079.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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28
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Carroll AJ, Huffman MD, Zhao L, Jacobs DR, Stewart JC, Kiefe CI, Brunner W, Liu K, Hitsman B. Associations between depressive symptoms, cigarette smoking, and cardiovascular health: Longitudinal results from CARDIA. J Affect Disord 2020; 260:583-591. [PMID: 31539696 PMCID: PMC6931258 DOI: 10.1016/j.jad.2019.09.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/08/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Depression is associated with increased risk of incident and recurrent cardiovascular disease, while the association between depression and cardiovascular health (CVH) remains unknown. Because the natural course of depression varies widely, different patterns of depression, as well as co-occurring factors such as cigarette smoking, may influence this relationship. We examined potential interactions between longitudinal patterns of depression and smoking with CVH. METHODS Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we modeled trajectories of depression (Center for Epidemiologic Studies Depression scale scores; Years 5, 10, 15, 20) and smoking (cigarettes/day; Years 0, 2, 5, 7, 10, 15, 20). We calculated a modified American Heart Association (AHA) CVH Score (weight, blood glucose, cholesterol, blood pressure, physical activity, and diet; Year 20); higher scores indicate better CVH. Generalized linear models evaluated associations between depression trajectories, smoking trajectories, and their interaction with CVH Score. RESULTS The depression trajectory x smoking trajectory interaction was not associated with CVH Score, but main effects of depression trajectory (p < .001) and smoking trajectory (p < .001) were observed. Participants with patterns of subthreshold depression (β = -0.26, SE=0.08), increasing depression (β = -0.51 SE = 0.14), and high depression (β = -0.65, SE = 0.32) had lower CVH Scores than those without depression. Compared to never smokers, participants who quit smoking had higher CVH Scores (β = 0.38, SE = 0.11), while participants with the greatest smoking exposure had lower CVH Scores (β = -0.49, SE = 0.22). LIMITATIONS CVH Scores were adapted from the AHA guidelines based on the available CARDIA data. CONCLUSIONS Deleterious depression and smoking trajectories are independently but not synergistically associated with worse CVH.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine, Chicago, IL, USA.
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Resarch Institute, Cooperstown, NY, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5816] [Impact Index Per Article: 969.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, Akbaraly T. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry 2019; 24:965-986. [PMID: 30254236 PMCID: PMC6755986 DOI: 10.1038/s41380-018-0237-8] [Citation(s) in RCA: 459] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 02/07/2023]
Abstract
With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews under the number CRD42017080579.
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Affiliation(s)
- Camille Lassale
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom.
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, United Kingdom.
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Amaria Baghdadli
- Department of Psychiatry & Autism Resources Centre, University Hospital of Montpellier, CHRU de Montpellier, F-34000, France
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Felice Jacka
- Deakin University, Food & Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Almudena Sánchez-Villegas
- Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Ciber de Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tasnime Akbaraly
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
- Department of Psychiatry & Autism Resources Centre, University Hospital of Montpellier, CHRU de Montpellier, F-34000, France
- MMDN, University of Montpellier, EPHE, INSERM, U1198, Montpellier, F-34095, France
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Zhang Z, Jackson S, Merritt R, Gillespie C, Yang Q. Association between cardiovascular health metrics and depression among U.S. adults: National Health and Nutrition Examination Survey, 2007–2014. Ann Epidemiol 2019; 31:49-56.e2. [PMID: 30665827 PMCID: PMC10083895 DOI: 10.1016/j.annepidem.2018.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The American Heart Association has identified seven modifiable cardiovascular health (CVH) metrics, including four health behaviors (body mass index, smoking, physical activity, and dietary intake) and three health factors (total cholesterol, blood pressure, and fasting glucose). We sought to examine the association between CVH metrics and depression. METHODS We analyzed data on 14,561 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2007-2014. Depressive symptoms were assessed using the Patient Health Questionnaire; a score of 0-4, 5-9, and 10 or higher represented no or minimal, mild, moderate or severe depressive symptoms, respectively. CVH was categorized as inadequate, average, or optimum. We used multinomial logistic regression to assess the association between CVH and depression, adjusted for age, gender, race or ethnicity, education, and alcohol use. RESULTS Prevalence of inadequate, average, and optimum CVH were 6.1%, 59.7%, and 34.2%; 14.9% and 7.8% of adults had mild and moderate/severe depression, respectively. Compared with participants with optimum CVH, prevalence ratios for moderate or severe depression were 4.39 (95% confidence interval, 3.32-5.80) and 2.64 (2.15-3.24) for those with inadequate and average CVH, respectively. The corresponding prevalence ratios for mild depression were 2.11 (1.77-2.52) and 1.36 (1.19-1.55). The association appeared to be stronger for CVH behaviors. CONCLUSIONS There was a graded association between CVH metrics, particularly for health behaviors, and mild and moderate/severe depression among U.S. adults.
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Poorer cardiovascular health is associated with psychiatric comorbidity: results from the ELSA-Brasil Study. Int J Cardiol 2019; 274:358-365. [DOI: 10.1016/j.ijcard.2018.06.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 02/08/2023]
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Liu RS, Wake M, Grobler A, Cheung M, Lycett K, Ranganathan S, Edwards B, Dwyer T, Azzopardi P, Juonala M, Burgner DP. Cross-sectional associations between Ideal Cardiovascular Health scores and vascular phenotypes in 11- to 12-year-olds and their parents: The Longitudinal Study of Australian Children. Int J Cardiol 2018; 277:258-265. [PMID: 30449694 DOI: 10.1016/j.ijcard.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/24/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Understanding early-life relationships between the Ideal Cardiovascular Health (ICVH) score and vascular phenotypes could inform likely effectiveness and timing of cardiovascular disease prevention strategies. We aimed to describe associations between ICVH scores and vascular phenotypes in 11- to 12-year-old children and their parents. METHODS AND RESULTS Cross-sectional ICVH scores (range 0-7, higher indicating better health), derived by summing dichotomized metrics for cholesterol, glucose, blood pressure (BP), body mass index (BMI), diet, physical activity and smoking, were constructed for 1235 adults (89% female, mean age 43 years) and 1028 children (48% female, 12 years). The median scores were 4 and 5 for adults and children respectively. Child ICVH scores were associated with parent scores (0.18 higher child score per additional point in parent's score, 95% CI 0.12 to 0.22, P < 0.001). Each additional point in the adult ICVH score was associated with slower carotid-femoral pulse wave velocity (PWV, -0.32 m/s, 95% CI -0.37 to -0.27), greater carotid elasticity (0.017%/mm Hg, 95% CI 0.014 to 0.020) and reduced carotid intima-media thickness (IMT, -7.3 μm, 95% CI -12.0 to -2.5). An additional point in the child score was associated with functional phenotypes (PWV -0.07 m/s, 95% CI -0.11 to -0.03; carotid elasticity 0.009%/mm Hg, 95% CI 0.004 to 0.015) but not structural phenotypes (IMT -1.8 μm, 95% CI -5.2 to 1.5). CONCLUSION Few Australian children and even fewer parents have ideal cardiovascular health. Lower ICVH scores were associated with adverse adult vascular phenotypes and adverse child vascular function. Family-based interventions optimizing ICVH metrics may delay onset and progression of subclinical atherosclerosis and later cardiovascular disease.
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Affiliation(s)
- Richard S Liu
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Auckland, Auckland, New Zealand; The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anneke Grobler
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia
| | - Kate Lycett
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia
| | - Ben Edwards
- ANU Centre for Social Research and Methods, Research School of Social Sciences, College of Arts and Social Sciences, The Australian National University, Canberra, Australia
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Peter Azzopardi
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Maternal and Child Health Program, Discipline of International Development, Burnet Institute, Melbourne, Australia; Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - David P Burgner
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
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Brewer LC, Redmond N, Slusser JP, Scott CG, Chamberlain AM, Djousse L, Patten CA, Roger VL, Sims M. Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study. J Am Heart Assoc 2018; 7:e008855. [PMID: 29871857 PMCID: PMC6015384 DOI: 10.1161/jaha.118.008855] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. METHODS AND RESULTS Using a community-based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative stress scores were associated with decreased odds (odds ratio [OR]) of achieving intermediate/ideal levels for smoking (OR [95% confidence interval], 0.80 [0.73-0.88], 0.84 [0.75-0.94], and 0.81 [0.74-0.90], respectively). Participants with more major life events had decreased odds of achieving intermediate/ideal levels for smoking (OR, 0.84; 95% confidence interval, 0.76-0.92) and fasting plasma glucose (OR, 0.90; 95% confidence interval, 0.82-0.98). Those with higher scores for minor stressors and major life events were less likely to achieve intermediate or ideal LS7 composite scores (OR [95% confidence interval], 0.89 [0.81-0.97] and 0.91 [0.84-0.98], respectively). CONCLUSIONS Blacks with higher levels of multiple stress measures are less likely to achieve intermediate or ideal levels of overall cardiovascular health (LS7 composite score), specific behaviors (smoking), and biological factors (fasting plasma glucose).
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Affiliation(s)
| | - Nicole Redmond
- National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Luc Djousse
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4771] [Impact Index Per Article: 681.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fernandez-Navarro P, Aragones MT, Ley V. Leisure-time physical activity and prevalence of non-communicable pathologies and prescription medication in Spain. PLoS One 2018; 13:e0191542. [PMID: 29352280 PMCID: PMC5774808 DOI: 10.1371/journal.pone.0191542] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/08/2018] [Indexed: 01/01/2023] Open
Abstract
Our aims were to describe physical activity (PA) behaviour in Spain and to examine its association with the prevalence of some of the major non-communicable diseases and with the use of prescription medication. Individualized secondary data retrieved from the 2014 European Health Interview Survey (EHIS) for Spain were used to conduct a cross-sectional epidemiological study (n = 18926). PA was assessed by two different measures: a specific designed variable for EHIS and a leisure time PA frequency-based query of the national survey. Diseases analyzed were hypertension, diabetes, hypercholesterolemia, depression and anxiety. The use of prescription medication was also included in the study. Weighted percentages were computed and contingency tables were calculated to describe PA by levels of the traits and sociodemographic characteristics. Chi-square test was used to compare percentages between groups and weighted logistic regression models were used to assess the relationship between PA and the prevalence of the disease. About 73% of the Spanish population performs no PA at all or only occasionally during their leisure time, and only one third meets minimum PA international guidelines (≥ 150min/week). Men are considerably more active than women and less PA is observed as the education level decreases and as age increases. The risk of the diseases evaluated was up to three times higher among inactive individuals. This study provides national population-based estimations highlighting the impact of PA in Spain, not only in the prevalence of some of the major non-communicable diseases but also in reducing prescription medication, and the potential sex and socioeconomic influence.
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Affiliation(s)
- Pablo Fernandez-Navarro
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- * E-mail: (PFN); (VL)
| | - María Teresa Aragones
- Department of Sports and Health, Spanish Agency for Health Protection in Sports, National Sports Council, Madrid, Spain
| | - Victoria Ley
- Department of Sports and Health, Spanish Agency for Health Protection in Sports, National Sports Council, Madrid, Spain
- * E-mail: (PFN); (VL)
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Osondu CU, Aneni EC, Valero-Elizondo J, Salami JA, Rouseff M, Das S, Guzman H, Younus A, Ogunmoroti O, Feldman T, Agatston AS, Veledar E, Katzen B, Calitz C, Sanchez E, Lloyd-Jones DM, Nasir K. Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study. Mayo Clin Proc 2017; 92:S0025-6196(17)30088-5. [PMID: 28365099 DOI: 10.1016/j.mayocp.2016.12.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. PARTICIPANTS AND METHODS Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. RESULTS Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. CONCLUSION Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population.
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Affiliation(s)
- Chukwuemeka U Osondu
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Ehimen C Aneni
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL
| | - Javier Valero-Elizondo
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Cátedra de Cardiología y Medicina Vascular, Tecnológico de Monterrey, Nuevo León, Mexico
| | - Joseph A Salami
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
| | - Maribeth Rouseff
- Wellness Advantage Administration, Baptist Health South Florida, Miami, FL
| | - Sankalp Das
- Wellness Advantage Administration, Baptist Health South Florida, Miami, FL
| | - Henry Guzman
- Wellness Advantage Administration, Baptist Health South Florida, Miami, FL
| | - Adnan Younus
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
| | - Oluseye Ogunmoroti
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
| | - Theodore Feldman
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Arthur S Agatston
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Emir Veledar
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Barry Katzen
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL
| | | | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine and Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Khurram Nasir
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Wellness Advantage Administration, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6362] [Impact Index Per Article: 795.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Veromaa V, Kautiainen H, Saxen U, Malmberg-Ceder K, Bergman E, Korhonen PE. Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers. Scand J Public Health 2016; 45:50-56. [DOI: 10.1177/1403494816677661] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. Method: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. Results: The prevalence of having 5–7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms ( p<0.001) and type D personality ( p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. Conclusions: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.
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Affiliation(s)
- Veera Veromaa
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
- Central Satakunta Health Federation of Municipalities, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, FinlandÕ) Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Ulla Saxen
- Department of Psychiatry, Hospital District of Satakunta, Finland
| | - Kirsi Malmberg-Ceder
- Institute of Clinical Medicine, Department of Neurology, University of Turku and Turku, University Hospital, Finland
| | - Elina Bergman
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
| | - Päivi E. Korhonen
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
- Central Satakunta Health Federation of Municipalities, Finland
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Prevalence and Metrics Distribution of Ideal Cardiovascular Health: A Population-based, Cross-sectional Study in Rural China. Heart Lung Circ 2016; 25:982-92. [DOI: 10.1016/j.hlc.2016.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 11/20/2022]
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Peng H, Mete M, Desale S, Fretts AM, Cole SA, Best LG, Lin J, Blackburn E, Lee ET, Howard BV, Zhao J. Leukocyte telomere length and ideal cardiovascular health in American Indians: the Strong Heart Family Study. Eur J Epidemiol 2016; 32:67-75. [PMID: 27660162 DOI: 10.1007/s10654-016-0199-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/14/2016] [Indexed: 01/17/2023]
Abstract
Telomere length, a marker of biological aging, has been associated with cardiovascular disease (CVD) and its risk factors. Ideal cardiovascular health (CVH), defined by the American Heart Association (AHA), has also been associated with a reduced risk of CVD, but the relationship between telomere length and ideal CVH is unclear. We measured leukocyte telomere length (LTL) by qPCR in 2568 American Indians in the Strong Heart Family Study (SHFS). All participants were free of overt CVD at enrollment (2001-2003). CVH indices included four behavioral factors (smoking, physical activity, diet, BMI) and three health factors (blood pressure, cholesterol, fasting glucose). Each index was categorized as poor, intermediate, or ideal according to the AHA's guideline. CVH was further categorized into below average (0-1), average (2-3) and above average (≥4) based on the total number of ideal indices. Results showed that, 29, 50 and 21 % of study participants had below average, average, and above average CVH, respectively. Participants with above average CVH had significantly longer LTL than those with below average CVH (β = 0.034, P = 0.042) after adjusting for age, sex, education level, marital status, processed meat consumption, alcohol consumption, and study site. Compared to the U.S. general population, American Indians achieved lower rates for five out of the seven ideal CVH metrics, including smoking, BMI, physical activity, diet, and blood pressure. Achieving four or more ideal CVH metrics was significantly associated with longer LTL. This finding suggests that achieving an ideal CVH may prevent or delay CVD, probably through promoting healthy aging.
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Affiliation(s)
- Hao Peng
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA.,Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, Timber Lake, SD, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, USA
| | - Elizabeth Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, USA
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | | | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA. .,Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA, USA.
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Abstract
Depression in patients who have had a myocardial infarction is an important clinical problem because it is extremely common and because the comorbidity complicates depression treatment and worsens the cardiovascular prognosis. Studies of psychotherapy, exercise, pharmacotherapy, and collaborative care demonstrate that effective treatment of depression is possible but the strength of the effects seen in most studies is low, and cardiovascular and all-cause morbidity and mortality benefits have not been proven. Recent collaborative care studies have had promising outcomes. For pharmacotherapy, side effects, including bleeding and arrhythmia risks, require special attention. Recovery from depression is associated with better long-term cardiovascular prognosis, while treatment per se is not.
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43
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Hintsa T, Wesolowska K, Elovainio M, Strelau J, Pulkki-Råback L, Keltikangas-Järvinen L. Associations of temporal and energetic characteristics of behavior with depressive symptoms: A population-based longitudinal study within Strelau's Regulative Theory of Temperament. J Affect Disord 2016; 197:196-204. [PMID: 26994438 DOI: 10.1016/j.jad.2016.02.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/03/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Individual dispositions have previously been associated with increased risk for depressive symptoms. The direction of the association has been found to be sometimes reciprocal. We examined whether temperament traits are associated with depressive symptoms and whether depressive symptoms contribute to changes in temperament. METHODS Participants (n=674-811) were from a population-based Young Finns Study. Temperament was assessed by a Finnish version of the Formal Characteristics of Behavior - Temperament Inventory. Depressive symptoms were assessed with modified BDI (mBDI) in 1997, 2001, 2007 and 2012, and BDI-II in 2012. RESULTS Higher perseveration and emotional reactivity were associated with higher level of depressive symptoms, and higher endurance was associated with lower level of depressive symptoms in 2007 and 2012. These associations were independent of several potential confounders and baseline depressive symptoms. The results of cross-lagged structural equation modeling showed that the associations between temperament and depressive symptoms were reciprocal: briskness, endurance and activity decreased the risk for depressive symptoms while depressive symptoms decreased the level of these characteristics. Perseveration, emotional reactivity and depressive symptoms reinforced each other over time. LIMITATIONS The depressive symptoms scales we used are not meant for measuring clinically diagnosed depression. The relationships between temperament traits and depressive symptoms were not strong enough to provide a clinical basis for guiding treatment. CONCLUSIONS Lower perseveration, lower emotional reactivity and higher endurance seem to be health protective temperament characteristics that reduce the risk for depressive symptoms. The reciprocal associations between temperament and depressive symptoms imply mutual health protective and health declining effects. Clinical relevance of the study is that enhancing positive loops and self-concept, and supporting individual stress management might be helpful in prevention of depressive symptoms.
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Affiliation(s)
- T Hintsa
- University of Helsinki, Institute of Behavioural Sciences, P.O. Box 9, FIN-00014 Helsinki, Finland.
| | - K Wesolowska
- University of Helsinki, Institute of Behavioural Sciences, P.O. Box 9, FIN-00014 Helsinki, Finland
| | - M Elovainio
- University of Helsinki, Institute of Behavioural Sciences, P.O. Box 9, FIN-00014 Helsinki, Finland; The National Institute for Health and Welfare, Helsinki, Finland
| | - J Strelau
- University of Social Sciences and Humanities, Faculty of Psychology, Poland
| | - L Pulkki-Råback
- University of Helsinki, Institute of Behavioural Sciences, P.O. Box 9, FIN-00014 Helsinki, Finland; Collegium for Advances Studies, University of Helsinki, Finland
| | - L Keltikangas-Järvinen
- University of Helsinki, Institute of Behavioural Sciences, P.O. Box 9, FIN-00014 Helsinki, Finland
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44
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Younus A, Aneni EC, Spatz ES, Osondu CU, Roberson L, Ogunmoroti O, Malik R, Ali SS, Aziz M, Feldman T, Virani SS, Maziak W, Agatston AS, Veledar E, Nasir K. A Systematic Review of the Prevalence and Outcomes of Ideal Cardiovascular Health in US and Non-US Populations. Mayo Clin Proc 2016; 91:649-70. [PMID: 27040086 DOI: 10.1016/j.mayocp.2016.01.019] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
Several population-based studies have examined the prevalence and trends of the American Heart Association's ideal cardiovascular health (CVH) metrics as well as its association with cardiovascular disease (CVD)-related morbidity and mortality and with non-CVD outcomes. However, no efforts have been made to aggregate these studies. Accordingly, we conducted a systematic review to synthesize available data on the distribution and outcomes associated with ideal CVH metrics in both US and non-US populations. We conducted a systematic search of relevant studies in the MEDLINE and CINAHL databases, as well as the Cochrane Register of Controlled Trials (CENTRAL). Search terms used included "life's simple 7", "AHA 2020" and "ideal cardiovascular health". We included articles published in English Language from January 1, 2010, to July 31, 2015. Of the 14 US cohorts, the prevalence of 6 to 7 ideal CVH metrics ranged from as low as 0.5% in a population of African Americans to 12% in workers in a South Florida health care organization. Outside the United States, the lowest prevalence was found in an Iranian study (0.3%) and the highest was found in a large Chinese corporation (15%). All 6 mortality studies reported a graded inverse association between the increasing number of ideal CVH metrics and the all-cause and CVD-related mortality risk. A similar relationship between ideal CVH metrics and incident cardiovascular events was found in 12 of 13 studies. Finally, an increasing number of ideal CVH metrics was associated with a lower prevalence and incidence of non-CVD outcomes such as cancer, depression, and cognitive impairment. The distribution of ideal CVH metrics in US and non-US populations is similar, with low proportions of persons achieving 6 or more ideal CVH metrics. Considering the strong association of CVH metrics with both CVD and non-CVD outcomes, a coordinated global effort for improving CVH should be considered a priority.
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Affiliation(s)
- Adnan Younus
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Ehimen C Aneni
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Internal Medicine, Mount Sinai Medical Center, Miami, FL
| | - Erica S Spatz
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Chukwuemeka U Osondu
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Lara Roberson
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Oluseye Ogunmoroti
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Rehan Malik
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Shozab S Ali
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Muhammad Aziz
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Theodore Feldman
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Arthur S Agatston
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL
| | - Emir Veledar
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Khurram Nasir
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD; Miami Cardiac and Vascular Institute, Miami, FL.
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45
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Abstract
An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose-response curve and the potential existence of a nonlinear threshold effect have not yet been established.
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46
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Guo L, Guo X, Chang Y, Li Z, Yu S, Yang H, Sun Y. Modified Ideal Cardiovascular Health Status is Associated with Lower Prevalence of Stroke in Rural Northeast China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:207. [PMID: 26861368 PMCID: PMC4772227 DOI: 10.3390/ijerph13020207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/03/2016] [Indexed: 01/01/2023]
Abstract
Background: In 2010, the American Heart Association developed a new definition of ideal cardiovascular health (CVH) based on seven cardiovascular health metrics. This study aimed to investigate the relationship between modified ideal CVH metrics and the risk of stroke in the rural population of Northeast China. Methods: We included 11,417 adults from the rural population in Northeast China and collected all the information, including the baseline characteristics, history of stroke, and the seven ideal CVH metrics. Results: Our results showed that the presence of stroke was associated with high body mass index (BMI), poor diet score (salt intake), high total cholesterol (TC), high blood pressure (BP), and high fasting plasma glucose (FPG). The prevalence of stroke increased as the number of ideal CVH metrics decreased, and peaked to 13.1% among those with only one ideal CVH metric. Participants with only one ideal CVH had a 4.40-fold increased susceptibility of stroke than those with all seven ideal health metrics. Conclusion: This study revealed that people with a better CVH status had a lower prevalence of stroke and the susceptibility of stroke increased with the decreasing of the number of ideal CVH metrics.
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Affiliation(s)
- Liang Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Ye Chang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang 110000, China.
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47
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Gaye B, Prugger C, Perier MC, Thomas F, Plichart M, Guibout C, Lemogne C, Pannier B, Boutouyrie P, Jouven X, Empana JP. High level of depressive symptoms as a barrier to reach an ideal cardiovascular health. The Paris Prospective Study III. Sci Rep 2016; 6:18951. [PMID: 26743318 PMCID: PMC4705528 DOI: 10.1038/srep18951] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/25/2015] [Indexed: 11/09/2022] Open
Abstract
We hypothesized that depression might represent a barrier to reach an ideal cardiovascular health (CVH) as estimated by the 7-item tool proposed by the American Heart Association. Between 2008 and 2012, 9,417 subjects 50-75 years of age were examined in a large health center and enrolled in the Paris Prospective Study III (PPS3). Participants with 0-2, 3-4 and 5-7 health metrics at the ideal level were categorized as having poor, intermediate and ideal CVH, respectively. Participants with a score ≥ 7 on the 13-item Questionnaire of Depression 2nd version, Abridged or who were on antidepressants were referred as having high level of depressive symptoms (HLDS). The mean age of the 9417 study participants was 59.57 (SD 6.28) years and 61.16% were males. A total of 9.55% had HLDS. Poor, intermediate and ideal CVH was present in 40.38%, 49.52% and 10.10% of the participants. In multivariate polytomous logistic regression analysis, HLDS was inversely associated with ideal CVH (odds ratio = 0.70; 95% CI: 0.55;0.90). This was driven by an association with the behavioural component of the CVH. Participants with HLDS had a substantial reduced chance of reaching an ideal CVH.
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Affiliation(s)
- B Gaye
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - C Prugger
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - M C Perier
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - F Thomas
- Preventive and Clinical Investigation Center, Paris, France
| | - M Plichart
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Hospital Broca, Department of Geriatry, Paris, France
| | - C Guibout
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - C Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Georges Pompidou European Hospital, Psychiatry Department, Paris, France.,INSERM U894, Neuropsychiatry, Paris, France
| | - B Pannier
- Preventive and Clinical Investigation Center, Paris, France
| | - P Boutouyrie
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France
| | - X Jouven
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France
| | - J P Empana
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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48
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3804] [Impact Index Per Article: 380.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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49
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Pilkerton CS, Singh SS, Bias TK, Frisbee SJ. Changes in Cardiovascular Health in the United States, 2003-2011. J Am Heart Assoc 2015; 4:e001650. [PMID: 26396200 PMCID: PMC4599487 DOI: 10.1161/jaha.114.001650] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/24/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011. METHODS AND RESULTS CVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd-numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of "poor" CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of "ideal" was observed for blood glucose followed by smoking, whereas the lowest prevalence of "ideal" was observed for physical activity and diet. Between 2003 and 2009, prevalence of "ideal" smoking and diet status increased, while "ideal" prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003-2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology. CONCLUSIONS Overall, CVHI decreased, most likely due to decreases in "ideal" blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of "ideal" physical activity and diet status. These findings can be used to inform state-specific strategies and targets to improve cardiovascular health.
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Affiliation(s)
- Courtney S Pilkerton
- School of Medicine, West Virginia UniversityMorgantown, WV
- School of Public Health, West Virginia UniversityMorgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Robert C. Byrd Health Sciences CenterMorgantown, WV
| | - Sarah S Singh
- School of Medicine, West Virginia UniversityMorgantown, WV
- School of Public Health, West Virginia UniversityMorgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Robert C. Byrd Health Sciences CenterMorgantown, WV
| | - Thomas K Bias
- School of Public Health, West Virginia UniversityMorgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Robert C. Byrd Health Sciences CenterMorgantown, WV
- Health Research Center, West Virginia University Robert C. Byrd Health Sciences CenterMorgantown, WV
| | - Stephanie J Frisbee
- School of Public Health, West Virginia UniversityMorgantown, WV
- Center for Basic and Translational Stroke Research, West Virginia University Robert C. Byrd Health Sciences CenterMorgantown, WV
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50
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Association between Ideal Cardiovascular Health Metrics and Depression in Chinese Population: A Cross-sectional Study. Sci Rep 2015; 5:11564. [PMID: 26176196 PMCID: PMC4648472 DOI: 10.1038/srep11564] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/12/2015] [Indexed: 12/30/2022] Open
Abstract
The study aimed to examine the association between ideal cardiovascular health (CVH) metrics and depression. We conducted a population-based, cross-sectional study of 6,851 participants aged 20 years or older (3,525 men and 3,326 women) living in Tangshan City, China. Information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose) was collected via questionnaires, physical examination and laboratory test. Depression status was assessed using the Epidemiologic Studies Depression Scale (CES-D) and a score of 16 or above was considered depression. The relationship between CVH metrics and depression was analyzed using logistic regression. Of the 6,851 participants, 525 (7.7%) were in depression status. After adjustment for potential confounders, men in the highest quartile of ideal CVH metric summary score had a reduced likelihood of having depression compared to those in the lowest quartile (adjusted odds ratio (AOR): 0.46, 95% confidence interval (CI): 0.28-0.75, p = 0.002). A similar trend was found among women, even though the association was not significant (AOR = 0.74, 95%CI: 0.46-1.18, p = 0.211). This study suggested that better CVH status is associated with a lower risk of depression especially in Chinese male and young population.
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