Level of Depression Tied to Increased Risk of Heart Disease And Stroke

Photo of Yosef M. Khan, M.D., M.P.H., Ph.D.Yosef Khan, M.D., Ph.D., Director, Health Informatics and Analytics, Center for Health Metrics and Evaluation, American Heart Association

Level of depression is strongly related to living with heart disease or stroke, with more severe depression tied to higher odds of having a heart condition.

This preliminary research finding will be presented Nov. 16, 2019, at the American Heart Association’s annual Scientific Sessions meeting in Philadelphia. The Association’s Scientific Sessions is an annual, premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

We conducted this research to learn more about the association and impact between depression and non-fatal cardiovascular diseases among U.S. adults, given that these conditions are widespread and previous studies have suggested a relationship between the two.

We reviewed data for more than 11,400 participants ≥20 years old, (representing 231.1 million adults) from the National Health and Nutrition Examination Surveys (NHANES) 2013-2014 and 2015-2016 who were diagnosed with depression. Participants were defined as having non-fatal cardiovascular disease if they had been diagnosed with congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack or stroke. Depression was assessed using a 9-item questionnaire that assigned participants to one of four levels of depression: mild, moderate, moderately severe and severe.

Each level increase in depression raised the odds of having a CVD outcome by 27%. After we adjusted for other variables that could affect risk, including age, sex, race/ethnicity, income, education and the American Heart Association’s Life’s Simple 7 factors, the odds were still raised by 24% for each level increase in depression.

Clarifying the relationship to inform prevention and treatment

Cardiovascular diseases are impacted by and related to a variety of aspects of health and well-being, including mental health. Because of previous research and our current study, we’re more aware of this connection now than ever, but we need more details about how it works. For example, it’s not clear if depression causes CVD or the other way around, and our study wasn’t designed to answer that question.

We also didn’t look at the relationship between CVD and depression by age, sex, race/ethnicity or other groupings to know if the strength of the connection varies by demographic or other characteristics. This will be an important next step to further evaluate the association, extent and impact of these two conditions in society.

Additional, different types of studies to better understand the relationship would be a welcome contribution—the implications are huge, given the increase that we observed in odds of CVD outcomes among people living with depression. More details will help us zero in on effective strategies to identify, prevent and treat both conditions.