Cardiovascular health (“Life’s Essential 8”), risk of depression and anxiety: a prospective cohort study

Background: There is a growing interest in the linkage of cardiovascular health (CVH) with depression/anxiety but the evidence of the latest “Life’s Essential 8” is scarce. We aimed to evaluate prospective associations of “Life’s Essential 8” CVH score redefined in 2022 with risk of incident depression and anxiety. Methods: Based on the latest definition of CVH score (“Life’s Essential 8”), we calculated the total score (0-800 points) based on eight components (0-100 points/component) including diet, physical activity, smoking, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure. Hospital records and mental health questionnaires were employed to yield the baseline prevalence and incidence of depression and anxiety. To address potential genetic confounding and gene-CVH interactions, we quantified genetic risk for both disorders using polygenic scores derived from genome-wide association studies. Results: Participants with a lower CVH score more often experienced depression, anxiety, and either disorder. During the follow-up, 17,554 incident events with symptoms of either disorder were recorded. Per 100-point decrease in CVH score was significantly associated with an increased risk of incident either disorder (Hazard ratio [HR]=1.149, 95% confidence interval [CI]:1.128-1.170), depression (HR=1.232, 95% CI:1.205-1.260), and anxiety (HR=1.045, 95% CI:1.018-1.072). Sleep duration was the key component related to the risk of depression/anxiety by providing much better estimates of the risks of depression/anxiety. A higher genetic risk could further significantly enhance the impact of worsened CVH on the incidences of either disorder and depression. Conclusions: Poor CVH is a risk factor for the incident late-life depression/anxiety symptoms of middle-aged and older adults and healthy behaviors especially sleep quality could be targeted for the risk assessment and intervention of depression/anxiety.