Changes in depressive symptoms as predictors of incident cardiovascular disease: insights from four prospective cohorts

Abstract Aims This study examines how changes in depressive symptoms influence cardiovascular disease (CVD) incidence in diverse ageing populations. Methods and results Data from four longitudinal cohorts were harmonized: China Health and Retirement Longitudinal Study (China), English Longitudinal Study of Ageing (UK), Health and Retirement Study (USA), and Mexican Health and Aging Study (Mexico). Depressive symptoms were assessed at baseline and follow-up using validated scales, and scores were standardized using z-scores. The primary outcome was incident CVD, defined as a composite of heart attack, angina, congestive heart failure, other physician-diagnosed heart conditions, and stroke. Cox proportional regression analyses assessed the associations between changes in depressive symptoms and CVD risk. Progression from no depression to mild depression was associated with a 28% increase in CVD risk (95% CI, 1.14–1.44), while progression to moderate-to-severe depression was associated with a 23% increase (95% CI, 1.04–1.46). Conversely, remission from mild depression to no depression significantly reduced CVD risk by 19% (95% CI, 0.68–0.98). Improvement from moderate-to-severe depression to mild depression decreased CVD risk by 25% (95% CI, 0.61–0.93), and remission from moderate-to-severe depression to no depression reduced it by 38% (95% CI, 0.50–0.76). Each 1-unit increase in the total depression score raised CVD risk by 12% (95% CI, 1.10–1.14), while each 1-unit increase in depression score change increased risk by 15% (95% CI, 1.11–1.19). Effects were stronger in participants aged <65 years than participants aged ≥65 years. Conclusion This multinational cohort study demonstrates that worsening or progression of depressive symptoms increases CVD risk, while remission or improvement confers protective effects, highlighting the need to monitor depression symptom changes in CVD prevention.