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February 8, 2026European Heart Journal

Association of depression, physical functioning and incident cardiovascular disease: a national cohort study

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Key result

Depression and impaired physical function linked to ~37% higher incident CVD risk.

Why the study?

Impaired physical functioning and depression are interconnected, but epidemiological data were needed to examine whether they interact, mediate, or synergistically contribute to incident CVD risk.

Do depression and impaired physical functioning synergistically increase the risk of incident cardiovascular disease in middle-aged and older adults?

Population

10,137 middle-aged and older adults without pre-existing CVD in China

Comparison

Depression and impaired physical functioning vs absence of these conditions

Design

National prospective cohort study

Follow-up

Mean 7.7 years

Authors

DWDan WuYLY LanCWC Wu

Discussion

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Overview

Supports integrated mental-physical assessment in CVD risk evaluation; extends observational data but remains hypothesis-generating pending randomized trials.

Key Points

  • This study investigates the interaction between depression, physical functioning, and the risk of cardiovascular disease in a national Chinese population.
  • Included 10,137 middle-aged and older adults without pre-existing cardiovascular disease
  • Used physical mobility and activities of daily living to assess physical functioning
  • Depression assessed with the CESD-10 scale
  • Conducted causal mediation analysis to explore the relationships among variables
  • 1,922 incident cases of cardiovascular disease recorded over a mean follow-up of 7.7 years
  • Depression associated with a 19% increased risk of cardiovascular disease
  • Impaired activities of daily living and physical mobility increased cardiovascular risk by 25% and 26%; depression status refined the risk association
  • Individuals with both depression and impaired functioning had a 36% to 38% increased risk of cardiovascular disease

Structured PICO

Do depression and impaired physical functioning synergistically increase the risk of incident cardiovascular disease in middle-aged and older adults?

P
Population
10,137 middle-aged and older adults without pre-existing CVD from a national, prospective cohort in China
I
Intervention
Depression (CESD-10 score ≥10) and impaired physical functioning (impaired physical mobility and activities of daily living)
C
Comparator
Absence of depression and normal physical functioning
O
Outcome
Incident cardiovascular disease (CVD)hard clinical

Depression and impaired physical functioning exhibit a dual-mediating role and are synergistically associated with an increased risk of incident CVD, highlighting the need for integrated physical and mental health assessments in CVD prevention.

Cite This Study

Wu et al. (2025) studied this question. Depression and impaired physical functioning jointly increase incident CVD risk by 36-38%, with physical function mediating 19-34% of depression's effect in 10,137 Chinese adults.

synapsesocial.com/papers/6988277b0fc35cd7a884642bhttps://doi.org/10.1093/eurheartj/ehaf784.3851
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Dynamic Interactions Among Activities of Daily Living, Depressive Symptoms, and Incident Cardiovascular Disease in Chinese Adults Aged 45 and Older: A 7-Year Longitudinal Study2025
  2. 2Joint association of depression and physical activity with incident cardiometabolic multimorbidity (CMM) among middle-aged and older adults in China2026 · 1 citations
  3. 3Association Between Depression and Risk of Incident Cardiovascular Diseases and Its Sex and Age Modifications: A Prospective Cohort Study in Southwest China2022 · 27 citations
  4. 4The longitudinal bidirectional association between cardiovascular disease and depressive symptoms among middle-aged and elderly adults: evidence from a nationwide cohort study in China2025 · 3 citations
  5. 5Cumulative Joint Burden of Functional Limitation and Depressive Symptoms on Cardiovascular Disease Risk :A Nationwide Bidirectional Mediation and Competing Risks Analysis2025