Mental health status and cardiovascular outcomes across Life's Essential 8 categories

Anxiety and depression are established risk factors for cardiovascular disease (CVD); impacts of these conditions on cardiovascular outcomes across different levels of cardiovascular health (CVH), measured by Life's Essential 8 (LE8) scores, remain unclear. We analyzed 290,778 UK Biobank participants (mean age 56.5, 56.1% male) without prior CVD. CVH was assessed using the LE8 score. Mental health status (healthy, anxiety only, depression only, or comorbid anxiety and depression) was determined through PHQ-4 items and ICD-10 codes (F32-F33 for depression, F40-F41 for anxiety). Cardiovascular outcomes were defined as a composite of coronary heart disease (CHD), heart failure (HF), and stroke. Cox proportional hazards models were adjusted for confounders and stratified by LE8 score (<50 [poor CVH] vs. ≥50 [intermediate-optimal]). Compared to the mentally healthy group, participants with comorbid anxiety and depression had the highest overall cardiovascular risk (adjusted HR 1.85 [95% CI 1.74-1.97]). The impact of mental health status varied according to baseline LE8 scores. Among those with LE8 <50, isolated anxiety (adjusted HR 1.23 [1.09-1.40]), depression (adjusted HR 1.34 [1.22-1.47]), as well as comorbid anxiety and depression (adjusted HR 1.46 [1.31-1.64]) were all associated with increased cardiovascular risk. In the LE8 ≥50 group, isolated anxiety (adjusted HR 1.39 [1.30-1.48]), isolated depression (adjusted HR 1.52 [1.43-1.60]), and comorbid anxiety and depression (adjusted HR 1.78 [1.66-1.90]) were all associated with increased risk. Mental health independently affects cardiovascular risk, modified by baseline CVH. Mental health emerge as a relative risk predictor among individuals with CVH (LE8 ≥ 50). • The impact of mental health on CVD risk is significantly modified by baseline LE8 score ( P -for-interaction < 0.005). • The relationship is non-additive, with excess risk from mental health peaking in the ‘Intermediate’ CVH group. • Achieving ‘Optimal’ CVH status (a subset of LE8 ≥ 50) nearly eliminates the excess CVD risk from mental disorders. • Comorbid anxiety and depression show the highest overall risk (composite outcome HR 1.85, 95% CI 1.74-1.97) in the total cohort.