Key result
High psychological distress was not independently associated with incident major CVD after adjusting for sociodemographic and physical health factors (multi-time-point HR 1.09; 95% CI 0.93-1.27).
Why the study?
Whether psychological distress directly increases cardiovascular disease risk is unclear due to methodological limitations, including limited evidence comparing longer-term versus single time-point distress assessments.
Does high psychological distress directly increase the risk of incident major cardiovascular disease in CVD-free and cancer-free adults?
Cohort (n=83,906)
Does high psychological distress directly increase the risk of incident major cardiovascular disease in CVD-free and cancer-free adults?
Hazard Ratio: 1.09 (95% CI 0.93–1.27)
The apparent association between psychological distress and incident cardiovascular disease is largely explained by confounding from sociodemographic factors and pre-existing functional limitations.
High distress is not independently linked to incident CVD after adjustment; leaves open whether it is causal or a confounded marker in observational data.
OBJECTIVE: Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study. DESIGN: We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations. RESULTS: Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26). CONCLUSION: Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.
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Welsh et al. (2021) conducted a cohort in Cardiovascular disease (n=83,906). High psychological distress vs. Low psychological distress was evaluated on Major CVD (HR 1.09, 95% CI 0.93 to 1.27). High psychological distress was not independently associated with incident major CVD after adjusting for sociodemographic and physical health factors (multi-time-point HR 1.09; 95% CI 0.93-1.27).
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