Late-life Depression: Better CV Health Reduces the Risk – Major Depressive Disorder: Contemporary Approaches

While vascular risk factors are thought to play a causal role in late-life depression, data on the connection between cardiovascular health and depressive symptoms are sparse. However, a new prospective study published in JAMA Psychiatry offers new insights, reporting on patients followed for both cardiovascular health and depressive symptoms over 19 years.¹

For their analysis, the authors included patients without depressive symptoms drawn from a large community-based cohort in France, known as the GAZEL cohort. A total of 6980 patients were studied. Their mean age was 53.3 years; 23.9% of the cohort were women; and the majority were White.

Participants were examined serially for both cardiovascular health and clinically relevant depressive symptoms, assessed via behavioral and biological metrics from the American Heart Association (nonsmoking and intermediate or ideal levels of body mass index, physical activity, dietary habits, blood pressure, blood glucose, and total cholesterol) and the 20-item Center for Epidemiologic Studies-Depression Scale (CES-D). While older studies looking for links between cardiovascular health and depressive symptoms have included just 1 or 2 follow-up examinations spanning 4 years or fewer, the current study goes further, with 6 follow-up exams over nearly 2 decades.

Higher cardio scores = lower odds of depression

During the 19-year follow-up, 26.5% of participants (n=1858) self-reported depressive symptoms.¹ Better cardiovascular health at baseline and improved cardiovascular health over 7 years both equated to lower odds of developing depressive symptoms in the future (odds ratio [OR] 0.87 per additional metric at an intermediate or ideal level at baseline, 95% confidence interval [CI] 0.84 to 0.91; and OR 0.91 per 1 higher metric at an intermediate or ideal level over 7 years, 95% CI 0.86 to 0.96, respectively). These findings expand upon prior work, including the Framingham Heart Study, which also drew a clear line between higher scores on cardiovascular health measures and lower risk of depressive symptoms. 

“Earlier studies on change in cardiovascular health with various other outcomes, including incident dementia, showed less strong effects,” says the current study’s lead author Thomas van Sloten, MD, PhD, a clinical scientist at the Department of Vascular Medicine, University Medical Center Utrecht, in the Netherlands. “The fact that all results showed a positive effect of better cardiovascular health on the risk of depressive symptoms provides strong evidence for the validity of our findings.”

Picking up on depressive trajectories 

Part of the study’s value lies in its focus on the trajectories of depressive symptoms. While prior prospective studies have not followed this outcome, Dr. van Sloten and his colleagues point out that the longitudinal course of depressive symptoms varies widely from patient to patient.

In the present study, better cardiovascular health was associated with a lower risk of negative depressive symptom trajectories. Participants with the lowest risk were those who had an initially low score that increased over time (OR 0.70 per additional metric at an intermediate or ideal level at baseline, 95% CI 0.64 to 0.76; OR 0.73 per 1 higher metric at an intermediate or ideal level over 7 years, 95% CI 0.68 to 0.79) and an initially moderately high score that increased over time (OR 0.71 per additional metric at an intermediate or ideal level at baseline, 95% CI 0.64 to 0.79; OR 0.71 per 1 higher metric at an intermediate or ideal level over 7 years, 95% CI 0.64 to 0.77).

Late-life depression: prevention is key!

In cases where current antidepressant medications have less than the desired effect on older patients, preventive measures will be crucial in addressing late-life depression, the authors suggested. 

“Prevention of late-life depression is key to improving health-related quality of life among older individuals,” Dr. van Sloten says. “I’m convinced that, for effective prevention, it’s crucial to identify mechanisms that can be targeted at an early disease stage.”

Although this study suggests that improving cardiovascular health throughout life may be related to a lower risk of depressive symptoms, preventive interventions will likely need to target multiple risk factors given the complicated pathophysiology of late-life depression. And while certain cardiovascular health metrics may foreshadow the development of depressive symptoms, future research is necessary to determine which set of cardiovascular risk factors should be prioritized in this setting.

Therefore, in lieu of targets for early preventive therapies, Dr. van Sloten has this advice for healthcare professionals: “In daily practice, clinicians could use these results to stimulate individuals to improve their cardiovascular health. This might not only prevent the development of cardiovascular disease but also depressive symptoms.” 

Published: July 28, 2023