Longitudinal Associations of Cumulative Depression Burden With Cardiovascular Diseases and All‐Cause Death Among Middle‐Aged and Older Population: Evidence From 2 Nationwide Cohort Studies

BACKGROUND: Depression is a known risk factor for cardiovascular disease (CVD), but the impact of long-term depressive symptom burden remains unclear. We examined the association between cumulative depression burden and risks of CVD and all-cause death among adults aged ≥50 years in China and Mexico. METHODS: Data were obtained from 2 nationally representative cohorts: CHARLS (China Health and Retirement Longitudinal Study) and MHAS (Mexican Health and Aging Study). Cumulative depression burden was quantified using 2 approaches: (1) the area under the curve of repeated depression scores and (2) the number of waves with depression. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident CVD and all-cause death. RESULTS: The analysis included 5277 CVD-free participants from CHARLS and 4779 from MHAS. Higher cumulative depression burden was significantly associated with elevated risk of CVD. Compared with the lowest-quartile group, participants in the highest-quartile group had significantly greater CVD risk (CHARLS: HR, 1.723 [95% CI, 1.420-2.090]; MHAS: HR, 1.739 [95% CI, 1.347-2.245]). Dose-response associations were observed in both cohorts. Persistent depression was also linked to higher CVD risk compared with isolated or less frequent episodes. Associations with all-cause death differed by cohort, with significant associations observed in CHARLS but not in MHAS. CONCLUSIONS: Long-term cumulative depression burden is strongly associated with increased CVD risk among adults aged ≥50 years. Routine screening and sustained management of depressive symptoms should be considered integral to CVD prevention strategies.