Abstract TH218: Effect Modification of Age and Sex in the Association between Depression and Coronary Heart Disease: National Health and Nutrition Examination Survey 1999-2023

Introduction: Heart disease and depression are leading causes of morbidity worldwide, with well-documented co-occurrence. However, the role of age and sex as effect modifiers in the depression-coronary heart disease (CHD) relationship remains unclear. Understanding these interactions may help develop tailored screening and intervention strategies. Hypothesis: Age and sex modify the association between depression and coronary heart disease (CHD) in a nationally representative sample. Methods: Cross-sectional analyses of National Health and Nutrition Examination Survey (NHANES) data from 1999-2023 (excluding 2019-2020) among adults aged ≥ 20 years were conducted. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression models were fitted to examine the depression-CHD association, to assess age and sex as effect modifiers. Models were adjusted for BMI, smoking, alcohol use, health insurance, sedentary activity, and hypertension. Results: Among 24,666 analytical participants, mean age was 49.5±17.7 years, 50.9% were women, 10% had moderate-to-severe depression, and 4% had CHD (Table 1). In adjusted models, both depression (OR: 1.07, 95% CI: 1.05-1.09) and age (OR: 1.08, 95% CI: 1.07-1.09) were significantly associated with CHD. Compared to minimal depression, moderate (OR: 2.30, 95% CI: 1.55-3.42), moderately severe (OR: 2.28, 95% CI: 1.42-3.65), and severe depression (OR: 2.92, 95% CI: 1.53-5.58) were associated with higher odds of CHD , while mild depression was not significant (OR: 1.20, 95% CI: 0.94-1.53). (Table 2). Compared to younger adults, middle-aged (OR: 7.66, 95% CI: 4.24-13.83) and older adults (OR: 32.81, 95% CI: 18.26-58.96) had substantially higher likelihood of CHD (Table 3). No significant age-depression interactions were observed. Sex showed evidence of effect modification (OR: 1.06, 95% CI: 1.03-1.08), though results were inconsistent across model specifications. Conclusions: Depression severity and age independently predict CHD risk, with consistent associations across age groups. The depression-CHD relationship does not appear to be modified by age, suggesting that depression screening and cardiovascular risk assessment strategies may be universally important across adult age groups. These findings highlight the need for enhanced CHD screening protocols in individuals with depression, regardless of age.