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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (3): 465-470. doi: 10.19723/j.issn.1671-167X.2023.03.012

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Joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease with the cardiovascular disease in middle-aged and elderly people in China

Zi-wei ZHANG,Yu-meng HUA,Ai-ping LIU*()   

  1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
  • Received:2023-02-28 Online:2023-06-18 Published:2023-06-12
  • Contact: Ai-ping LIU E-mail:apingliu@bjmu.edu.cn

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Abstract:

Objective: To explore joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease (CVD) in middle-aged and elderly people in China. Methods: Based on China Health and Retirement Longitudinal Study(CHARLS)database using 2011 baseline data and the follow-up cohort data of 2013, 2015 and 2018, describe the distribution characteristics of baseline depressive symptoms and 10-year risk of ischemic cardiovascular disease in 2011. Cox survival analysis model was used to analyze the individual, independent and joint association of depression symptoms and 10-year risk of ischemic cardiovascular disease with cardiovascular disease. Results: A total of 9 412 subjects were enrolled. The detection rate of depressive symptoms at baseline was 44.7%, and the 10-year middle and high risk of ischemic cardiovascular disease was 13.62%. During an average follow-up of 6.19 (6.19±1.66) years, 1 401 cases of cardiovascular disease were diagnosed in 58 258 person-years, revealing an overall incidence density of 24.048/1 000 person-years. After adjusting the factors, in terms of individual impact, the participants with depressive symptoms had a higher risk of developing CVD (HR=1.263, 95%CI: 1.133-1.408), while medium to high risk of ischemic cardiovascular disease had a higher risk of developing CVD (HR=1.892, 95%CI: 1.662-2.154). Among independent influences, participants with depressive symptoms had a higher risk of developing CVD (HR=1.269, 95% CI: 1.138-1.415), while medium to high risk of 10-year risk of ischemic cardiovascular disease had a higher risk of developing CVD (HR=1.898, 95%CI: 1.668-2.160). Joint impact result showed the incidence of cardiovascular disease in the low risk of 10-year risk of ischemic cardiovascular disease with depressive symptoms group, middle and high risk of 10-year risk of ischemic cardiovascular disease without depressive symptoms group, and 10-year middle and high risk of ischemic cardiovascular disease with depressive symptoms group were 1.390, 2.149, and 2.339 times higher than that of low risk of 10-year risk of ischemic cardiovascular disease without depressive symptoms (P < 0.001). Conclusion: The superimposed depression symptoms of the middle and high-risk population at the 10-year risk of ischemic cardiovascular disease will aggravate the risk of cardiovascular disease in middle-aged and elderly people. In combination with the actual lifestyle intervention and physical index health management, attention should be paid to mental health intervention.

Key words: Depressive symptoms, Ischemic cardiovascular disease, Cardiovascular disease, Joint association

CLC Number: 

  • R193.3

Table 1

Population distribution characteristics of baseline depressive symptoms and ICVD risk"

Characteristics nDepressive symptoms ICVD risk level
No, n(%) Yes, n(%) χ2 P Low risk, n(%) Moderately-high-risk, n(%) χ2 P
Age/years
  45- 3 734 2 114 (56.61) 1 620 (43.39) 7.186 0.066 3 552 (95.13) 182 (4.87) 483.120 < 0.001
  55- 3 451 1 906 (55.23) 1 545 (44.77) 2 886 (83.63) 565 (16.37)
  65- 1 644 883 (53.71) 761 (46.29) 1 275 (77.55) 369 (22.45)
  75- 583 302 (51.80) 281 (48.20) 417 (71.53) 166 (28.47)
Gender
  Male 4 526 2 819 (62.3) 1 707 (37.7) 171.980 < 0.001 4 058 (89.7) 468 (10.3) 79.753 < 0.001
  Female 4 886 2 386 (48.8) 2 500 (51.2) 4 072 (83.3) 814 (16.7)
Area
  Rural 5 846 3 048 (52.1) 2 798 (47.9) 62.470 < 0.001 5 088 (87.0) 758 (13.0) 5.623 0.018
  Urban 3 566 2 157 (60.5) 1 409 (39.5) 3 042 (85.3) 524 (14.7)
Education
  Primary school and below 6 181 3 156 (51.1) 3 025 (48.9) 166.770 < 0.001 5 193 (84.0) 988 (16.0) 85.914 < 0.001
  Junior middle school 1 999 1 189 (59.5) 810 (40.5) 1 811 (90.6) 188 (9.4)
  Senior high school 995 683 (68.6) 312 (31.4) 909 (91.4) 86 (8.6)
  Junior college and above 237 177 (74.7) 60 (25.3) 217 (91.6) 20 (8.4)
Marital status
  Married 8 312 4 726 (56.9) 3 586 (43.1) 69.640 < 0.001 7 289 (87.7) 1 023 (12.3) 104.274 < 0.001
  Divorced/unmarried/widowed 1 100 479 (43.5) 621 (56.5) 841 (76.5) 259 (23.5)
Smoking status
  Never 5 687 2 972 (52.3) 2 715 (47.7) 57.170 < 0.001 4 898 (86.1) 789 (13.9) 18.889 < 0.001
  Quit 719 453 (63.0) 266 (37.0) 659 (91.7) 60 (8.3)
  Smoke 3 006 1 780 (59.2) 1 226 (40.8) 2 573 (85.6) 433 (14.4)
Disability
  No 9 111 5 081 (55.8) 4 030 (44.2) 25.029 < 0.001 7 868 (86.4) 1 243 (13.6) 0.117 0.733
  Yes 301 124 (41.2) 177 (58.8) 262 (87.0) 39 (13.0)
BMI/(kg/m2)
  Normal 5 065 2 792 (55.1) 2 273 (44.9) 27.339 < 0.001 4 659 (92.0) 406 (8.0) 618.576 < 0.001
  Lighter 586 267 (45.6) 319 (54.4) 534 (91.1) 52 (8.9)
  Overweight 2 711 1 551 (57.2) 1 160 (42.8) 2 267 (83.6) 444 (16.4)
  Obesity 1 050 595 (56.7) 455 (43.3) 670 (63.8) 380 (36.2)
Sleep
  ≥6 h 6 865 4 266 (62.1) 2 599 (37.9) 480.087 < 0.001 5 969 (86.9) 896 (13.1) 6.986 0.008
   < 6 h 2 547 939 (36.9) 1 608 (63.1) 2 161 (84.8) 386 (15.2)
Hypertension
  No 5 958 3 281 (55.1) 2 677 (44.9) 0.356 0.551 5 856 (98.3) 102 (1.7) 1 956.999 < 0.001
  Yes 3 454 1 924 (55.7) 1 530 (44.3) 2 274 (65.8) 1 180 (34.2)
Diabetes
  No 7 254 3 996 (55.1) 3 258 (44.9) 0.591 0.442 6 667 (91.9) 587 (8.1) 821.975 < 0.001
  Yes 2 158 1 209 (56.0) 949 (44.0) 1 463 (67.8) 695 (32.2)
Dyslipidemia
  No 6 793 3 784 (55.7) 3 009 (44.3) 1.601 0.206 6 046 (89.0) 747 (11.0) 142.896 < 0.001
  Yes 2 619 1 421 (54.3) 1 198 (45.7) 2 084 (79.6) 535 (20.4)

Table 2

CVD incidence density during follow-up in the middle-aged and elderly population in China"

Characteristics n Person-years of observations Cases of CVD, n Incidence density/per 1 000 person-years (95%CI)
Depressive symptoms
  No 5 205 32 421 693 21.375 (19.25-23.735)
  Yes 4 207 25 837 708 27.403 (24.678-30.428)
ICVD risk level
  Low risk 8 130 50 681 1 099 21.685 (19.092-24.630)
  Moderately-high-risk 1 282 7 577 302 39.857 (35.092- 45.270)

Figure 1

Baseline depressive symptoms, ICVD risk, and follow-up CVD ICVD, ischemic cardiovascular disease; CVD, cardiovascular disease."

Table 3

Cox survival analysis association of depressive symptoms and ICVD between CVD"

Characteristics n CVD, n Crude HR (95%CI) Adjust HRa (95%CI) Adjust HRb (95%CI)
Individual impact
  Depressive symptoms
    No 5 205 693 1.000
    Yes 4 207 708 1.301(1.172-1.445)* 1.314(1.182-1.461)* 1.263(1.133-1.408)*
  ICVD risk level
    Low risk 8 130 1 099 1.000
    Moderately-high-risk 1 282 302 1.928(1.697-2.190)* 1.899(1.669-2.161)* 1.892(1.662-2.154)*
Independent influence
  Depressive symptoms
    No 5 205 693 1.000
    Yes 4 207 708 1.295(1.167-1.438)* 1.318(1.186-1.466)* 1.269(1.138-1.415)*
  ICVD risk level
    Low risk 8 130 1 099 1.000
    Moderately-high-risk 1 282 302 1.922(1.692-2.183)* 1.904(1.673-2.167)* 1.898(1.668-2.160)*
Interactive item
  Depressive symptoms×ICVD risk level 0.793(0.615-1.025)# 0.783(0.607-1.011)# 0.778(0.602-1.004)#
Joint influence
  Depression symptoms and ICVD risk
    No depressive symptoms and low risk of ICVD 4 499 533 1.000
    Symptoms of depression and low risk of ICVD 3 631 566 1.361(1.210-1.532)* 1.339(1.185-1.512)* 1.390(1.233-1.566)
    No depressive symptoms and medium to high risk of ICVD 706 160 2.09(1.806-2.571)* 2.149(1.799-2.567)* 2.149(1.799-2.567)*
    Depression symptoms combined with high risk of ICVD 576 142 2.329(1.935-2.802)* 2.239(1.850-2.710)* 2.339(1.936-2.825)*
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