Poorer cardiovascular health is associated with psychiatric comorbidity: results from the ELSA-Brasil Study

Int J Cardiol. 2019 Jan 1:274:358-365. doi: 10.1016/j.ijcard.2018.06.037. Epub 2018 Jun 12.


Background: Common psychiatric symptoms may hinder achieving ideal cardiovascular health (ICH). We aimed to investigate the association between the ICH score and psychiatric disorders in Brazilian adults.

Methods: In this cross-sectional analysis, 13,743 participants free of cardiovascular disease from the ELSA-Brasil study were assessed using the American Heart Association ICH score. Cardiovascular health was classified as poor (0-2 ideal metrics), intermediate (3-4 ideal metrics), and optimal (5-7 ideal metrics). We used the Clinical Interview Scheduled Revised (CIS-R) to assess psychiatric disorders and investigate their association with the ICH score and each non-ICH metric.

Results: The frequency of poor, intermediate, and optimal cardiovascular health were 54.1%, 38.1%, and 7.8%, respectively. Depressive and anxiety disorders were associated with poor cardiovascular health (depressive disorder: OR = 2.49, 95% CI = 1.62-3.80, p < 0.001; anxiety disorder: OR = 1.47, 95% CI = 1.22-1.78, p < 0.001), and intermediate cardiovascular health (depressive disorder: OR = 1.94, 95% CI = 1.26-2.98, p = 0.002; anxiety disorder: OR = 1.22, 95% CI = 1.01-1.47, p = 0.043). In the analysis stratified by sex, these associations were significant only among women. The disorders were also associated with the following non-ICH metrics: body mass index, physical activity, healthy diet score, and smoking. Participants with depressive disorder and anxiety disorder had expected lower global and lifestyle ICH score than participants without these conditions, with significant results among women in the stratified analysis.

Conclusion: Psychiatric comorbidity was associated with poorer cardiovascular health. These conditions may compromise the adoption of healthy cardiovascular risk reduction behaviors.

Keywords: Anxiety; Depression; Ideal cardiovascular health; Lifestyle; Psychiatric diagnosis.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Brazil / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Comorbidity / trends
  • Cross-Sectional Studies
  • Female
  • Health Status*
  • Humans
  • Life Style*
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Sex Factors
  • Surveys and Questionnaires