Key result
CVD is linked to ~260% higher depression risk, amplified by high mental vulnerability.
Why the study?
The mechanisms linking cardiovascular disease (CVD) and depression are not yet established, prompting investigation into the impact of mental vulnerability on this relationship.
Does incident cardiovascular disease increase the risk of depression, and is this relationship modified or confounded by mental vulnerability?
Cohort (n=19,856)
Does incident cardiovascular disease increase the risk of depression, and is this relationship modified or confounded by mental vulnerability?
Hazard Ratio: 3.6 (95% CI 3.3–3.92)
Mental vulnerability does not fully explain the relationship between cardiovascular disease and depression, but individuals with high mental vulnerability who develop CVD have a synergistically increased risk of depression, highlighting a key group for targeted intervention.
CVD patients with high mental vulnerability face synergistically elevated depression risk; leaves open whether targeted screening alters outcomes in observational data.
BACKGROUND: The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression. METHODS: A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983-2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression. RESULTS: During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability. CONCLUSIONS: Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.
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Jørgensen et al. (2020) conducted a cohort in Cardiovascular disease and depression (n=19,856). Cardiovascular disease vs. No cardiovascular disease was evaluated on Depression (HR 3.60, 95% CI 3.30-3.92). Cardiovascular disease was associated with a 3.60-fold increased hazard of depression, a relationship that was not fully explained by mental vulnerability but showed synergistic interaction leading to more depression cases among highly vulnerable individuals.
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