Depression and risk of incident heart diseases among older adults at CKM stages 0-3: evidence from the China Health and Retirement Longitudinal Study.
Depression is associated with a higher risk of ischemic heart disease in older adults with cardiovascular kidney metabolic syndrome, but the clinical significance of this finding should be approached with caution.
Where it sits
this study against the rest of the epitalon (epithalon) corpusSummary and findings
This study investigated the association between depression and incident ischemic heart disease (IHD) in older adults at cardiovascular kidney metabolic (CKM) stages 0-3. Participants were assessed using the Center for Epidemiologic Studies Depression (CESD) scale, with a score of ≥10 indicating depression. The study found that depression was significantly associated with an increased risk of IHD.
Abstract
<h4>Background</h4>Evidence on the association between depression and incident ischemic heart disease (IHD) in individuals with cardiovascular kidney metabolic (CKM) syndrome is limited. This study investigated this association in older adults at CKM stages 0-3.<h4>Methods</h4>Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS). Participants meeting the criteria were included. Depression was defined as Center for Epidemiologic Studies Depression (CESD) scale ≥10. IHD mainly contained heart attack, coronary heart disease, angina, congestive heart failure. Association between depression and IHD was estimated in participants at CKM stage 0-3 using logistic regression models. The directed acyclic graph (DAG) was also used for variable selection. Association between depression and CKM stage 4 was also evaluated. Subgroup analyses (strata including sex, marital status, etc.), interaction p‑values and restricted cubic splines (RCS) were also conducted. Six sensitivity analyses were conducted, comprising using original data, inverse probability of treatment weighting (IPTW), treating the CESD score as both a categorical and continuous variable, etc. Simple mediation analyses were conducted to examine whether changes in BMI, CRP, and WBC mediated the depression‑IHD association.<h4>Results</h4>4,738 participants were included. After multivariable adjustment, depression was significantly associated with an increased risk of IHD (OR 1.62, 95%CI:1.34-2.03) and CKM stage 4 (OR 2.43, 95%CI:1.62-3.66). Similarly, when variables were selected by DAG, the OR was 1.67 (1.34,2.07) for IHD and 2.45 (1.66,3.64) for progression to CKM stage 4. The trend persisted across the 6 sensitivity analyses. RCS revealed a linear relationship between CESD score and IHD risk, with consistent associations across subgroups and no significant mediation effects.<h4>Conclusion</h4>Depression was prospectively associated with a higher risk of IHD among participants at CKM stages 0-3. This finding offers a new perspective for the management of IHD in the context of CKM syndrome.
Background
This paper addresses the link between depression and ischemic heart disease (IHD) in older adults, particularly those with cardiovascular kidney metabolic (CKM) syndrome. Previous research has suggested potential associations, but evidence remains limited, especially in this specific population. Understanding this relationship is crucial for managing IHD in older adults with CKM syndrome.
Methods
Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS), including participants with CKM stages 0-3. Depression was defined using the CESD scale with a threshold of ≥10. Logistic regression models were employed to estimate the association between depression and IHD, with subgroup analyses and sensitivity analyses conducted to validate findings.
Results
The primary endpoint indicated that after multivariable adjustment, depression was significantly associated with an increased risk of IHD, with an odds ratio (OR) of 1.62 (95%CI:1.34-2.03). Additionally, the study found an OR of 2.43 (95%CI:1.62-3.66) for the progression to CKM stage 4. The association persisted across various sensitivity analyses, reinforcing the robustness of the findings.
Interpretation
The findings align with previous literature suggesting a link between depression and cardiovascular outcomes, though the effect size may not be clinically significant. The study's observational nature and reliance on self-reported measures introduce potential confounding factors that limit the conclusions. Practitioners should consider these limitations when interpreting the results and applying them to clinical practice.
Key findings
- OR 1.62, 95%CI:1.34-2.03 for IHD after multivariable adjustment, n=4738.
- OR 2.43, 95%CI:1.62-3.66 for CKM stage 4 after multivariable adjustment.
- OR 1.67 (1.34,2.07) for IHD when variables were selected by DAG.
- OR 2.45 (1.66,3.64) for progression to CKM stage 4 when variables were selected by DAG.
Limitations
- observational study design may introduce confounding factors
- self-reported CESD scale could affect accuracy of depression diagnosis
- no direct causal relationship established
- limited to older adults at CKM stages 0-3