Risk of cardiovascular disease according to gender and lifestyle behaviors in adults with depressive symptoms: a prospective UK Biobank study

Abstract

Abstract Depression is a well-known risk factor of cardiovascular disease (CVD). However, how the relationship of depressive symptoms and CVD changes with gender and healthy lifestyle has not been studied. Therefore, we investigated the association between depressive symptoms and CVD risk according to gender and lifestyle. The UK Biobank is a national prospective cohort study that recruited middle-aged participants between 2006 and 2010. Depressive symptoms were assessed by self-reported frequency of depressive mood using the 2-week recall method. Participants were classified as having low, moderate, high, or very high symptom level according to the number of days they felt depressed in a 2-week period. The primary outcome was incident CVD including coronary artery disease, ischemic stroke, hemorrhagic stroke, peripheral artery disease, atrial fibrillation/flutter, and heart failure. Participants reporting more depressive symptoms were younger and more likely to have comorbidities and unfavorable lifestyle behaviors. During a median follow-up of 8.9 years, 27,394 (6.3%) developed CVD. As the frequency of depressive symptoms increased, CVD risk also increased. After adjusting for multiple variables, CVD risk was 1.38-fold higher for subjects with very high depressive symptoms compared to those with low depressive symptoms. (HR 1.38, 95% CI 1.24–1.53, P < 0.001). Among specific CVD outcomes, a significant relationship between depressive symptoms and CVD risk was observed in all subtypes except for hemorrhagic stroke. The correlation of depressive symptoms with CVD risk was more remarkable in females than in males. In subjects with high or very high depressive symptoms, no current smoking, normal weight, regular physical activity, and appropriate sleep duration were associated with lower CVD risk regardless of gender. However, eating habits did not affect the risk of CVD in subjects with depressive symptoms. We found that higher frequency of depressive symptoms is an independent risk factor of CVD. This association was prominent in women. In the population with depressive symptoms, engaging in a healthier lifestyle could prevent CVD risk regardless of gender.