The depression-heart connection: cardiovascular risks in cancer patients from NHANES 2005–2018

Previous studies have proved that depression is an independent risk factor of cardiovascular disease (CVD) in the general population. We conducted this analysis to explore whether depression symptoms are associated with an increased risk of developing CVD among cancer patients in the United States. The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018, with a total of 1890 cancer patients included in the analysis. A stratified multistage probability sampling design was used to select a nationally representative sample, ensuring demographic groups were proportionally represented. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and CVD risk was determined based on clinical and self-reported data. A weighted multivariate logistic regression analysis was conducted to assess the relationship between depression and CVD risk, adjusting for confounding factors. Subgroup analyses were performed to explore the associations across demographic subgroups. After adjusting for all covariates in the fully adjusted model (Model 3), CVD risk showed a significant association with depression severity. For each unit increase in PHQ-9 score, the adjusted odds ratio (AOR) for CVD was 1.09 (95% CI: 1.05–1.14, P < 0.001). Participants with severe depression exhibited markedly higher odds of CVD compared to those without depression (AOR=6.82,95%CI: 2.39–19.50, P < 0.001). Trend analysis revealed a graded relationship, with CVD risk increasing progressively across depression severity categories (P for trend < 0.001). Restricted cubic spline analysis confirmed a linear dose–response relationship (P for nonlinearity = 0.424), indicating that CVD risk escalates continuously with worsening depression severity. Our findings suggest that more severe depression is associated with higher CVD incidence in cancer populations. These observations highlight the need to consider depressive symptom monitoring as part of comprehensive care approaches that may help address cardiovascular risks in this vulnerable group.