Screening for depression can increase the effectiveness of the American Heart Association’s cardiovascular health assessment, allowing a more accurate prediction of cardiovascular mortality and mortality from all causes.
“Psychological health is multidimensional spanning positive mental states such as optimism and a sense of purpose, which are linked to better heart health, as well as depression, which is linked to higher risk for cardiovascular disease,” says senior study author Nour Makarem, an assistant professor of epidemiology at Columbia Mailman School, in a news release. “Although psychological health is foundational for cardiovascular health preservation, it is not currently included as a metric of cardiovascular health in the Life’s Essential 8,” she says, referring to the current AHA cardiovascular health assessment.
The AHA has already revised that assessment, formerly known as “Life’s Simple 7,” based on a 2022 study led by Makarem. Adding an eighth metric — sleep health — improved cardiovascular disease outcome prediction of the assessment, now dubbed “Life’s Essential 8.”
The study, which included more than 20,000 U.S. adults with an average age of 48, investigated a cardiovascular health score consisting of eight factors — diet, sleep health, physical activity, nicotine use, body-mass index or BMI, blood glucose, blood lipids and blood pressure — and the added measure for psychological health and wellbeing.
A high cardiovascular health score including the psychological health metric was associated with up to a 70% lower cardiovascular mortality risk and 77% mortality risk from all causes, compared with a low score. This was an improvement on the predictions of the current Life’s Essential 8 test, which was associated with 65% and 68% lower all-cause and cardiovascular mortality risk.
The study findings suggest that “substantial gains” in longevity may be achievable with improvement of cardiovascular health, including aspects of psychological health, Makarem says.
“We found that even a simple two-question screener of depression symptoms’ frequency could enhance the cardiovascular health construct and serve as a feasible measure of psychological health in clinical or public health settings where comprehensive assessments may not be possible,” she says.
A higher cardiovascular health score with the added the psychological health metric was associated with lower mortality risk in Black and white adults, but not in Hispanic adults. The results were stronger particularly among Black and female populations. Among Black adults, a high vs. low enhanced cardiovascular health score was associated with a more than double lower risk of mortality.
Makarem says more research is needed using more comprehensive definitions of psychological health and wellbeing. “A psychological health construct that encompasses aspects of psychological wellbeing such as gratitude, optimism, mindfulness as well as symptoms of depression, anxiety, and stress may better capture the complexity of mental health and its role in shaping cardiovascular health,” she says. “Future studies should test a more comprehensive psychological health construct that is also pragmatic and could easily be captured, particularly during an annual clinician visit.”
