Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA-Brasil

Acta Psychiatr Scand. 2019 Dec;140(6):552-562. doi: 10.1111/acps.13109. Epub 2019 Oct 20.


Objective: We investigated whether ideal cardiovascular health (ICH), a metric proposed by the American Heart Association, predicts depression development.

Methods: Cohort analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Adults with no current depression and other common mental disorders, cardiovascular diseases, and antidepressant drug use at baseline had their ICH (composite score of smoking, dietary habits, body mass index, blood pressure, fasting glucose, cholesterol, and physical activity) assessed and classified into poor, intermediate, and optimal. Depression was assessed using the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusted for sociodemographic factors and alcohol consumption, were employed. Stratified analyses were performed for age and sex.

Results: We included 9214 participants (mean age 52 ± 9 years, 48.6% women). Overall depression incidence at 3.8-year follow-up was 1.5%. Intermediate and poor ICH significantly increased the risk rate (RR) of developing depression (2.48 [95%CI 1.06-5.78] and 3 [1.28-7.03], respectively) at a 3.8-year follow-up. Higher ICH scores decreased the rate of depression development (RR = 0.84 [0.73-0.96] per metric). Stratified analyses were significant for women and adults < 55 years old.

Conclusions: Poor cardiovascular health tripled depression risk at follow-up in otherwise healthy adults. Ameliorating cardiovascular health might decrease depression risk development.

Keywords: cardiovascular health; cardiovascular risk factors; cohort study; depression incidence; major depressive disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brazil / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Depressive Disorder, Major / epidemiology*
  • Female
  • Health Status Indicators*
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Risk