Abstract
The prevalence of depressive symptoms among older adults has become an increasingly important public health priority. Elevated depressive symptoms are well documented among elderly people with cardiovascular disease (CVD), but studies conducted among Chinese adults are scarce. To estimate the association between depressive symptoms and incident CVD among middle-aged and older Chinese adults. The China Health and Retirement Longitudinal Study is an ongoing nationally representative prospective cohort study that was initiated in 2011. This cohort study included 12 417 middle-aged and older Chinese adults without heart disease and stroke at baseline. Statistical analysis was conducted from April 25, 2018, to December 13, 2018. Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale. Incident CVD (ie, self-reported physician-diagnosed heart disease and stroke combined) was followed-up from June 1, 2011, to June 31, 2015. The Center for Epidemiologic Studies Depression Scale total score ranges from 0 to 30, with a score of 12 or more indicating elevated depressive symptoms. Of the 12 417 participants (mean [SD] age at baseline, 58.40 [9.51] years), 6113 (49.2%) were men. During the 4 years of follow-up, 1088 incident CVD cases were identified. Elevated depressive symptoms were independently associated with an increased CVD risk (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.58) after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.39) and loneliness (adjusted hazard ratio, 1.21; 95% CI, 1.02-1.44), were significantly associated with incident CVD. Elevated depressive symptoms overall and 2 individual symptoms (restless sleep and loneliness) were significantly associated with incident CVD among middle-aged and older Chinese adults.
Highlights
Depressive symptoms are common among middle-aged and older adults.[1,2] China, like much of Asia, is experiencing an increase in older adults
Elevated depressive symptoms were independently associated with an increased cardiovascular disease (CVD) risk after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy
Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep and loneliness, were significantly associated with incident CVD
Summary
Depressive symptoms are common among middle-aged and older adults.[1,2] China, like much of Asia, is experiencing an increase in older adults. The prevalence of depressive symptoms in older adults has become an increasingly important public health priority.[3,4,5] A national survey in China[6] showed that approximately 30% of men and 43% of women aged 45 years and older experienced depressive symptoms. Epidemiological studies[7,8,9] have found that depressive symptoms are associated with a range of negative health outcomes, such as coronary heart diseases, stroke, and all-cause mortality. Some studies[10,11,12] found that both the history and new onset of depressive symptoms were associated with a series of cardiovascular events, such as angina, myocardial infarction, stroke, heart failure, and coronary death. The association between depression and incident cardiovascular disease (CVD) may vary across different depression subtypes[14] and may be bidirectional; for example, depressive symptoms are associated with an increased risk of CVD,[13] whereas cardiovascular risk factors are associated with depression or depressive symptoms.[15,16] to reduce the risk of CVD, it is important to understand its association with depressive symptoms
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