Association between cardiovascular health metrics and depression among US adults: National Health and Nutrition Examination Survey, 2007-2014

Purpose: The American Heart Association has identified seven modifiable cardiovascular health (CVH) metrics, including four health behaviors (body mass index, smoking, physical activity, and dietary intake) and three health factors (total cholesterol, blood pressure, and fasting glucose). We sought to examine the association between CVH metrics and depression. Methods: We analyzed data on 14,561 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2007-2014. Depressive symptoms were assessed using the Patient Health Questionnaire; a score of 0-4, 5-9, and 10 or higher represented no or minimal, mild, moderate or severe depressive symptoms, respectively. CVH was categorized as inadequate, average, or optimum. We used multinomial logistic regression to assess the association between CVH and depression, adjusted for age, gender, race or ethnicity, education, and alcohol use. Results: Prevalence of inadequate, average, and optimum CVH were 6.1%, 59.7%, and 34.2%; 14.9% and 7.8% of adults had mild and moderate/severe depression, respectively. Compared with participants with optimum CVH, prevalence ratios for moderate or severe depression were 4.39 (95% confidence interval, 3.32-5.80) and 2.64 (2.15-3.24) for those with inadequate and average CVH, respectively. The corresponding prevalence ratios for mild depression were 2.11 (1.77-2.52) and 1.36 (1.19-1.55). The association appeared to be stronger for CVH behaviors. Conclusions: There was a graded association between CVH metrics, particularly for health behaviors, and mild and moderate/severe depression among U.S. adults. (C) 2018 Elsevier Inc. All rights reserved.