Mental Health Disorders and the Development of Cardiovascular Disease: Insights from the All of Us Research Program.

To determine whether individuals with mental health disorders (MHDs) without a history of cardiovascular disease (CVD) have an increased incidence of future cardiovascular events. We conducted a prospective analysis with a study cohort derived from the All Of Us Research Program, examined 4 self-reported MHDs - anxiety disorder, bipolar disorder, depression, and post-traumatic stress disorder (PTSD) - and used Cox regression models to calculate the hazard ratios (HR) associated with each MHD for incident myocardial infarction (MI), stroke, and heart failure (HF). Models were adjusted for sex, race, age, hypertension, diabetes mellitus, hyperlipidemia, and smoking. Subgroup analysis was performed by sex. The time period was January 1, 2018 through July 1, 2022. A total of 119,740 participants were included in this study. All MHDs were associated with significantly higher risks of HF and composite CVD. The HRs and 95% confidence intervals for HF were: depression 1.25 (1.12 to 1.38), anxiety 1.28 (1.12 to 1.44), bipolar disorder 1.57 (1.24 to 1.98), and PTSD 1.40 (1.16 to 1.68); and for composite CVD were: depression 1.22 (1.11 to 1.34), anxiety 1.26 (1.12 to 1.41), bipolar disorder 1.38 (1.11 to 1.72), and PTSD 1.38 (1.17 to 1.62). In the subgroup analysis, all MHDs were associated with total CVD in females but not in males. This study demonstrated that individuals with MHDs without known CVD are more likely to develop future CVD, especially HF, although this was observed predominantly in women. A comprehensive evaluation for MHDs should receive greater attention as a part of a holistic approach to CVD prevention.