Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States

Purpose: This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. Design: Cross-sectional study. Setting: National Health and Nutrition Examination Survey data (2013-2018). Participants: A total of 14 699 community-dwelling adults (≥20 years). Measure: The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. Analysis: Adjusted prevalence ratios were estimated using a Poisson regression model. Results: The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR:1.42, P =.002) and moderately severe to severe depression (aPR:1.72, P =.024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P <.001) compared to males (aPRs range: 1.45 to 1.77, P <.001). Conclusion: Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.