Association of longitudinal changes in depressive symptoms and handgrip strength with cardiovascular disease in middle-aged and elderly populations.

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death among the elderly population. While handgrip strength and depressive symptoms have each been independently associated with CVD risk, their combined longitudinal changes assessed over two time points and their association with incident CVD have not been fully investigated. This study aimed to examine the association of longitudinal changes in these two factors with incident CVD in middle-aged and elderly individuals, with the goal of providing preliminary observational evidence for future prevention research in this population.

METHODS

Based on data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018, we used Cox proportional hazards regression models to analyze the independent and joint associations of longitudinal changes in handgrip strength and depressive symptoms with incident CVD. Longitudinal changes in both exposures were defined using two repeated measurements from 2011 to 2013.

RESULTS

Persistent and new-onset depressive symptoms were associated with a significant increase in incident CVD risk, with hazard ratios (HR) of 1.36 (95% CI: 1.11-1.66, P = 0.003) and 1.32 (95% CI: 1.04-1.66, P = 0.02), respectively. In quartile-based analyses of handgrip strength change, participants with the greatest increase in handgrip strength (Q4) had a 23% lower risk of incident CVD (HR = 0.77, 95% CI: 0.60-0.98, P = 0.03). An exploratory joint association was observed: in the subgroup of participants with new-onset depressive symptoms, the greatest increase in handgrip strength was associated with a 73% reduction in incident CVD risk (HR = 0.27, 95% CI: 0.13-0.56, P < 0.001).

CONCLUSIONS

This observational study suggests that longitudinal changes in depressive symptoms showed more consistent associations with incident CVD, whereas evidence for handgrip strength change was more limited and was mainly observed in quartile-based analysis. These findings highlight the potential relevance of the "muscle-psychological" interplay in cardiovascular health among middle-aged and elderly populations. The subgroup finding involving new-onset depressive symptoms and marked handgrip strength improvement should be considered exploratory.