Joint associations of cardiovascular health and depression with all-cause mortality among middle-aged and older adults

To examine the association between cardiovascular health (CVH), assessed using the American Heart Association’s Life’s Essential 8 (LE8) score, and depression, and to evaluate their independent and joint associations with all-cause mortality among adults aged 50 years and older. This prospective cohort study included 8,189 participants aged ≥ 50 years in the 2007–2018 National Health and Nutrition Examination Survey (NHANES). Participants with missing covariate data, incomplete LE8 measurements, or missing depression assessments were excluded. CVH was evaluated using the LE8 score encompassing four health behaviors (diet, physical activity, nicotine exposure, and sleep) and four health factors (body mass index, blood pressure, blood glucose, and non–high-density lipoprotein cholesterol). The overall LE8 score ranged from 0 to 100, with higher scores indicating more optimal CVH. CVH was categorized as low (< 50 points), moderate (50–79 points), or high (≥ 80 points). Depression was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10. Multivariable weighted logistic regression and Cox proportional hazards models were used to evaluate associations of CVH with depression and associations of CVH and depression with all-cause mortality, respectively, adjusting for age, sex, race/ethnicity, education level, alcohol intake, and cardiovascular disease history. Higher CVH scores were associated with lower odds of depression with a nonlinear association pattern (fully adjusted odds ratio [ OR ], 0.17; 95% CI , 0.07–0.38 for high vs. low CVH). Over a median follow-up of 65 months, 1,123 deaths occurred. Compared with participants with high CVH, those with moderate and low scores had higher all-cause mortality (hazard ratio [ HR ], 1.37; 95% CI , 1.03–1.83 and HR , 2.29; 95% CI , 1.53–3.41, respectively). Depression was independently associated with higher mortality risk ( HR , 1.54; 95% CI , 1.13–2.12). The coexistence of low CVH and depression conferred the highest risk ( HR , 3.14; 95% CI , 2.05–4.79). The presence of depression and lower CVH were each independently associated with higher all-cause mortality, and their coexistence identified a subgroup with substantially elevated mortality risk. These findings emphasize the need for integrated cardiovascular and mental health strategies to promote healthy aging.