Abstract TU240: Depression and 10-Year Cardiovascular Disease Risk in a Nationally Representative Sample using AHA PREVENT Equation

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of death in the United States. In 2023, the American Heart Association (AHA) introduced the PREVENT equation to precisely estimate 10-year risk for heart failure (HF), atherosclerotic CVD (ASCVD), and total CVD across diverse populations. PREVENT equation provides more accurate risk estimation than the previously used equations. Depression, a well-recognized yet under-quantified determinant of cardiovascular health, may influence estimated risk. We aim to examine the association between depression severity and predicted 10-year cardiovascular risk using the AHA PREVENT equations. Hypothesis: We hypothesized that higher depression severity would be associated with greater predicted 10-year cardiovascular risk, demonstrating a graded, dose-response relationship across depression categories. Methods: We analyzed data from the 2017-2018 National Health and Nutrition Examination Survey. Adults aged 30-70 years without self-reported or clinically diagnosed CVD who completed the Patient Health Questionnaire (PHQ-9) and had complete data for calculating PREVENT-based 10-year risk estimates were included (n ≈ 700). Per the PHQ-9, depression severity was classified as minimal/none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27). Predicted 10-year risk for HF, ASCVD, and total CVD was calculated using the PREVENT equations. Non-parametric Kruskal-Wallis tests, followed by Dunn pairwise comparisons, were conducted to asses group differences. Results: Depression severity was significantly associated with predicted 10-year risk for HF (p < 0.001), ASCVD (p < 0.001), and total CVD (p < 0.001). Predicted risk increased progressively across depression categories for all outcomes, consistent with a dose-response pattern. Individuals with higher depression scores demonstrated the greatest elevation in predicted HF risk, followed by total CVD and ASCVD. Individuals with mild to severe depressive symptoms had significantly higher estimated 10-year risk than those with minimal or no symptoms (all p < 0.05). Stepwise differences were observed between moderate, moderately severe, and severe depression categories, suggesting a graded association between symptom burden and cardiovascular risk. Conclusions: These findings highlight the importance of incorporating mental health assessment into cardiovascular risk stratification and prevention efforts.