Abstract
OBJECTIVE: Our study explored the association between depressive symptoms and non-fatal cardiovascular disease, as well as other significant risk factors for non-fatal cardiovascular disease, in middle-aged and elderly patients with hypertension in China. DESIGN: Prospective cohort study. SETTING: Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) database over a 9-year period (2011-2020). PARTICIPANTS: Middle-aged and elderly patients with hypertension aged 45 and above in China. OUTCOME MEASURES: Non-fatal cardiovascular disease was ascertained based on self-reported, physician-diagnosed heart disease. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale-10. RESULTS: A total of 1755 participants were enrolled in the prospective cohort study. The incidence of non-fatal cardiovascular diseases among patients with hypertension was 5 per 1000 person-months. There was a positive linear correlation between depressive symptoms and the risk of non-fatal cardiovascular diseases (p(non-linear)=0.625). Meanwhile, an inverted U-shaped relationship was identified between baseline duration of hypertension and risk of non-fatal cardiovascular diseases; those experiencing hypertension for 15 years had the highest risk, with the risk decreasing for durations above or below this value (p(non-linear) <0.001). Other risk factors identified were female gender (HR 1.19, 95% CI 1.01 to 1.40), health education (HR 0.81, 95% CI 0.70 to 0.95), comorbidity of diabetes (HR 1.60, 95% CI 1.30 to 1.97) and age (HR 1.01, 95% CI 1.01 to 1.02). CONCLUSIONS: This study demonstrates graded associations between depression severity and incident non-fatal cardiovascular disease in middle-aged and elderly patients with hypertension in China. The multivariable analysis identified five modifiable risk determinants: inadequate health education, advanced age, female gender, diabetes comorbidity and hypertension exposure duration of 7-21 years. These findings necessitate precision prevention strategies combining psychocardiological interventions with risk factor modification in high-risk subgroups.