Self-reported pain, depressive symptoms and risk for cardiovascular diseases

Q: What are the key findings of this study?

The combination of self-reported pain and depressive symptoms increased the risk of new-onset cardiovascular disease by 59% (HR 1.59) compared to individuals without either condition.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease risk (n=13184). Intervention: Self-reported pain and depressive symptoms vs. Without self-reported pain and without depressive symptoms. Primary outcome: New-onset cardiovascular disease (stroke or cardiac events) (HR 1.59, 95% CI 1.44-1.76, p=<0.001).

Q: What does this research mean for the field?

The co-occurrence of self-reported pain and depressive symptoms synergistically increases the risk of cardiovascular diseases, stroke, and cardiac events beyond the independent risk posed by either condition alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the independent and joint associations of self-reported pain and depressive symptoms with the risk of new-onset cardiovascular diseases, stroke, and cardiac events.

Xiaobo Mu; Xiaowei Zheng; 曹敏恺

doi:10.1038/s41598-026-73684-4

October 12, 2026Scientific ReportsOpen Access

Self-reported pain, depressive symptoms and risk for cardiovascular diseases

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Key result

Co-occurring pain and depressive symptoms are linked to ~59% higher risk of new-onset CVD.

HR 1.59
95% CI 1.44-1.76
P<0.001
n=13,184

Why the study?

Previous studies found pain and depressive symptoms are independently associated with cardiovascular diseases, but their joint association with CVD risk was unclear.

Does the joint presence of self-reported pain and depressive symptoms increase the risk of incident cardiovascular diseases in middle-aged and older adults?

Key Points

To investigate the independent and joint associations of self-reported pain and depressive symptoms with the risk of new-onset cardiovascular diseases, stroke, and cardiac events.
Analyzed prospective cohort data from 13,184 participants aged 45 years or older from the China Health and Retirement Longitudinal Study classified into 4 baseline symptom groups.
Used Cox proportional hazards regression models adjusting for demographic, behavioral, and clinical covariates over a 9-year follow-up.
Over the 9-year follow-up, 2,834 individuals developed cardiovascular disease: 18.12% without pain or depression, 22.25% with depressive symptoms alone, 24.38% with pain alone, and 28.37% with both.
Compared to participants without pain or depression, fully adjusted hazard ratios for cardiovascular disease were 1.23 (95% CI 1.11–1.37) for depression alone, 1.33 (95% CI 1.19–1.49) for pain alone, and 1.59 (95% CI 1.44–1.76) for both.
Individuals experiencing both pain and depressive symptoms faced the highest risk for both stroke (HR 1.71, 95% CI 1.45–2.01) and cardiac events (HR 1.60, 95% CI 1.43–1.79).

Study Design

Type

Cohort (n=13,184)

Multicenter

Yes

Structured PICO

Does the joint presence of self-reported pain and depressive symptoms increase the risk of incident cardiovascular diseases in middle-aged and older adults?

P

Population

13,184 middle-aged and older adults (mean age 58.6, 51.3% female) from China, followed for a median of 9 years to assess the joint association of self-reported pain and depressive symptoms with incident cardiovascular disease.

E

Exposure

Presence of both self-reported pain and depressive symptoms (assessed via CESD-10 score ≥ 10).

C

Comparator

Individuals without self-reported pain and without depressive symptoms.

O

Outcome

New cardiovascular disease (composite of stroke or cardiac event) occurring during the survey period from Waves 2 to 5, based on self-reported doctor diagnoses.composite

Main Result

Hazard Ratio: 1.59 (95% CI 1.44–1.76)

Absolute Event Rate: 28.37% vs 18.12%

p-value: p=<0.001

Limitations

Definition of CVD is based on self-reported physician diagnosis, which can lead to information bias.
The study targeted only the Chinese population aged 45 and above, limiting generalizability to younger individuals or other populations.
Exclusion of participants due to incomplete baseline or outcome data could introduce selection bias.
Definition of CVD based on self-reported physician diagnosis, which can lead to information bias
Only targeted Chinese population aged 45 and above, limiting generalizability to other populations or younger individuals
Exclusion of participants due to incomplete baseline information or outcome data could introduce selection bias

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Answers are grounded in this paper and cite their sources.

Implication

The co-occurrence of self-reported pain and depressive symptoms identifies a highly vulnerable phenotype with a synergistic risk for incident cardiovascular disease, suggesting a need for dual screening and management in older adults.

Abstract

Previous studies have found that both pain and depressive symptoms are deleteriously associated with cardiovascular diseases (CVD). The aim of current study was to investigate the joint association of pain and depressive symptoms with CVD risk. A total of 13,184 participants aged 45 years or older from the China Health and Retirement longitudinal study were included in current study. Participants were divided into 4 groups according to self-reported pain and depressive symptoms status. Cox proportional hazards regression model was used to explore the associations between self-reported pain/depressive symptoms and new-onset CVD, stroke and cardiac events. During the 9-year follow-up, a total of 2,834 individuals experienced CVD (including 965 stroke and 2,168 cardiac events). Both self-reported pain and depressive symptoms were independently associated with increased risk of CVD. Self-reported pain and depressive symptoms had additive and multiplicative interactions on CVD risk. Compared to individuals without self-reported pain/depressive symptoms, the adjusted hazard ratios (95% confidence intervals) were 1.23 (1.11–1.37) for those with depressive symptoms alone, 1.33 (1.19–1.49) with self-reported pain alone, and 1.59 (1.44–1.76) for those with both self-reported pain and depressive symptoms. Similarly, individuals with both self-reported pain and depressive symptoms were also with highest risk of stroke and cardiac events. Both self-reported pain and depressive symptoms were associated with increasing risk of CVD, individually. Those with pain and depressive symptoms had the highest risk of CVD, suggesting likely synergistic effects. Our findings support the need to target both pain and depressive symptoms in research and clinical practice.

Discussion

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Cite This Study

Mu et al. (2026) conducted a cohort in Cardiovascular disease risk (n=13,184). Self-reported pain and depressive symptoms vs. Without self-reported pain and without depressive symptoms was evaluated on New-onset cardiovascular disease (stroke or cardiac events) (HR 1.59, 95% CI 1.44-1.76, p=<0.001). The combination of self-reported pain and depressive symptoms increased the risk of new-onset cardiovascular disease by 59% (HR 1.59) compared to individuals without either condition.

synapsesocial.com/papers/6acd7b298476e147521be13e https://doi.org/10.1038/s41598-026-73684-4

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Self-reported pain, depressive symptoms and risk for cardiovascular diseases

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Self-reported pain, depressive symptoms and risk for cardiovascular diseases

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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