Associations of Midlife Vascular Risk Factors With Late‐Life Depressive Symptoms: Findings From the ARIC Study

BACKGROUND: The impact of midlife vascular health, which is strongly linked with other aspects of brain health, on late-life depression is not well understood. We examined the associations of midlife vascular risk factors (VRFs), and the burden of these factors, with late-life depressive symptoms (LLDSs). METHODS: Individuals from the ARIC (Atherosclerosis Risk in Communities) study, a population-based prospective study, were evaluated with 5 in-person visits from 1987 to 1989 (visit 1) through 2011 to 2013 (visit 5). Presence of midlife VRFs at visit 1 (smoking, hypertension, diabetes, obesity, and hypercholesterolemia) or midlife VRF burden (0, 1, 2, or ≥3 VRFs) were evaluated. LLDSs were defined by a Center for Epidemiological Studies Depression Scale score ≥9 at visit 5. Multivariable logistic regression analyses adjusted for age, sex, race-center, apolipoprotein E ε4 carrier status, and education. RESULTS: Among 6198 participants, at midlife (median age, 51 years; 59% women; 22% Black individuals), 20.2% had 0 VRFs, 41.3% had 1, 27.2% had 2, and 11.3% had ≥3 VRFs. In a combined model, midlife smoking (odds ratio [OR], 1.68 [95% CI, 1.33-2.13]), diabetes (OR, 1.42 [95% CI, 1.00-2.00]), hypertension (OR, 1.29 [95% CI, 1.03-1.62]), and obesity (OR, 1.51 [95% CI, 1.21-1.90]) were each independently associated with LLDSs. Compared with individuals with 0 VRFs in midlife, individuals with 2 (OR, 1.69 [95% CI, 1.21-2.36]) or ≥3 (OR, 2.34 [95% CI, 1.62-3.40]) VRFs had greater odds of LLDSs. CONCLUSIONS: Midlife VRFs, and the burden of these factors, were associated with LLDS. Midlife vascular health may be a potential target for prevention of depression in later life.