Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study

BACKGROUND: There remains a relative paucity of evidence for the association between changes in depressive symptoms with cardiovascular disease (CVD) and mortality. This study aimed to evaluate the association of change in depressive symptoms and incident CVD and mortality in a large prospective cohort of middle-aged and older adults. METHODS: A total of 6,810 participants free of CVD in the China Health and Retirement Longitudinal Study with two assessments of depressive symptoms at wave 1 (2011-2012) and wave 2 (2013-2014) were included. Elevated depressive symptoms were defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depression scale. We used a modified Poisson regression to examine the association of changes in depressive symptoms (never, onset, remitted, and persistent) and incident CVD (a composite endpoint of heart disease or stroke) and mortality at wave 3 (2015-2016). RESULTS: During follow-up, 457 CVDs and 148 deaths occurred. Multivariable analyses revealed that persistent depressive symptoms were associated with an elevated risk of CVD (risk ratio = 1.77, 95% confidence interval = 1.38-2.26) and mortality (risk ratio = 1.63, 95% confidence interval = 1.01-2.64) compared with participants without any depressive symptoms. New-onset depressive symptoms increased the mortality risk (risk ratio = 2.37, 95% confidence interval = 1.52-3.69), but not CVD (risk ratio = 1.15, 95% confidence interval = 0.84-1.58). Remitted depressive symptoms were associated with a 35% and 13% excess risk of CVD and mortality, respectively. CONCLUSION: Persistent and remitted depressive symptoms were associated with an increased risk of CVD. New-onset depressive symptoms predicted elevated mortality risk.