Depressive symptom trajectories preceding cardiovascular disease: Findings from three national cohorts

BACKGROUND: Early identification of cardiovascular disease (CVD) risk is crucial for prevention, but its long preclinical phase is difficult to detect. As depressive symptoms may be a measurable indicator during this period, this study aimed to characterize their long-term trajectory before an incident CVD diagnosis. METHODS: We conducted a longitudinal cohort study analyzing data from three large population-based studies: the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear mixed-effects models on a reverse timescale anchored at the date of CVD diagnosis and Cox proportional hazards models, we examined the trajectory of depressive symptoms and their association with incident CVD in adults free of CVD at baseline. RESULTS: The analysis included 48,952 adults. Over a median follow-up of 7.1 to 13.3 years, individuals who developed CVD experienced a significant acceleration in depressive symptoms well before their clinical diagnosis compared to event-free controls. This acceleration began approximately 8 to 16 years before the CVD event. Higher depressive symptoms were consistently associated with an increased risk of incident CVD across all cohorts (hazard ratios ranging from 1.05 to 1.08). CONCLUSIONS: A sustained rise in depressive symptoms constitutes a long-term prodromal phase that begins many years before a clinical CVD diagnosis. These findings suggest that monitoring changes in depressive symptoms could be a valuable tool for identifying individuals at higher risk for CVD, creating a critical window for targeted preventive strategies.