Combined impact of depressive and anxiety symptoms and cardiovascular health metrics on major adverse cardiovascular events: A prospective cohort study.

BACKGROUND

The interplay between psychological health and traditional cardiovascular health (CVH) metrics, and their joint impact on the risk of major adverse cardiovascular events (MACE), remain unclear.

METHODS

This study investigated the prospective association of depressive and anxiety symptoms, assessed by Patient Health Questionnaire-4 (PHQ-4) scores, and traditional CVH, measured by Life's Essential 8 (LE8) scores, with MACE risk in the UK Biobank cohort. MACE was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular mortality. Cox proportional hazards models evaluated the association of LE8 and PHQ-4 with MACE risk.

RESULTS

Among 95,098 participants (mean ± SD age, 55.58 ± 7.75 years; 42,526 [44.72 %] male), 3001 (3.2 %) experienced MACE during a mean follow-up of 12.73 years. Participants with low PHQ-4 scores and ideal CVH had the lowest risk of MACE compared to those with high PHQ-4 scores and poor CVH (HR, 0.263 [95 % CI, 0.183-0.377]). Higher CVH scores were consistently associated with reduced MACE risk, regardless of depressive and anxiety symptoms. Each 10-point increase in LE8 scores was associated with a significantly lower MACE risk in both participants with PHQ-4 scores <6 (HR 0.784, 95 % CI [0.759-0.810]) and with PHQ-4 scores ≥6 (HR 0.782, 95 % CI [0.679-0.901]). These findings remained robust across sensitivity analyses and subgroups.

CONCLUSIONS

Fewer symptoms of depression and anxiety, alongside optimal CVH, are independently and jointly associated with a lower risk of MACE. Integrating psychological health management with CVH optimization may enhance cardiovascular outcomes and reduce the burden of cardiovascular disease.