Depression and Cardiovascular Burden in Aging Populations: Insights From the National Health and Nutrition Examination Survey 2010-2020 on Symptom Frequency, Sociodemographic Disparities, and Modifiable Risk Factors.

Objective

Depression and cardiovascular disease (CVD) commonly co-occur in adults aged ≥50 years and older, yet the relationship between depressive symptom frequency and specific cardiovascular outcomes remains underexplored. The objective of this study was to investigate the association between symptom frequency and CVD across demographic and behavioral subgroups.

Methods

We analyzed data from 16,257 participants aged ≥50 years in the National Health and Nutrition Examination Survey (2010-2020). Depressive symptoms were categorized by self-reported frequency. CVD outcomes included coronary heart disease (CHD), myocardial infarction (MI), angina, and congestive heart failure (CHF). Survey-weighted logistic regression models estimated adjusted odds ratios (ORs) for cardiovascular outcomes by depressive symptom frequency, stratified by sex, race/ethnicity, body mass index (BMI), and smoking status.

Results

Depressive symptoms were reported by 24% of participants, with women more represented in moderate categories and men predominating in the highest-frequency group. Non-Hispanic black and Mexican American participants showed greater symptom burden. CVD prevalence increased stepwise with symptom frequency: CHD=7.3%-18.2% and MI=7.0%-13.6% (P<.001). Median BMI was significantly higher among those with depressive symptoms across all CVD subtypes. Co-occurring depressive symptoms with obesity(BMI ≥30, ORs= 3.2 and 3.1) or current smoking (ORs= 3.6 and 3.5) tripled the odds of CHD or angina and CHF or MI, respectively, compared to counterparts without these risk factors. Co-occurrence of CVD subtypes was more common in those with depressive symptoms, particularly in adults aged ≥65 years.

Conclusion

Depressive symptom frequency was independently associated with elevated CVD risk, especially in the presence of obesity or smoking. These findings support integrated screening and prevention strategies targeting both mental health and cardiometabolic risk in adults aged ≥50 years. Prim Care Companion CNS Disord 2026;28(2):25m04116. Author affiliations are listed at the end of this article.