Article · 2024 Paper GEO V2

Associations Between Cardiovascular Health (Life's Essential 8) and Mental Disorders

Clinical Cardiology

Full Authors

  1. Yudi Xu
  2. Wenjing Ning
  3. Yuyuan Zhang
  4. Yuhao Ba
  5. Huimin Liu
  6. Long Liu
  7. Libo Wang
  8. Chunguang Guo
  9. Hui Xu
  10. Siyuan Weng
  11. Zhaokai Zhou
  12. Zongao Cai
  13. Hongxuan Ma
  14. Ge Zhang
  15. Yanjie Jia
  16. Xinwei Han
DOI / publisher Google Scholar search Cite

Research Question

What association between cardiovascular health measured by Life’s Essential 8 and prevalent depressive symptoms is consistently supported by this NHANES analysis?

Author Evidence Summary

The study assessed adults in NHANES 2007–2012 using eight cardiovascular-health components and questionnaire-defined mental-health outcomes. The depression analysis used PHQ-9 scores of at least 10 and survey-weighted logistic regression adjusted for age, sex, race, marital status, poverty and education. The analytic sample, depression count and principal depression estimates agree across the abstract, body and Table 2. Higher LE8 scores were associated with lower odds of prevalent depressive symptoms. Anxiety was also studied, but its count and continuous estimate conflict between abstract and body/table; those findings are excluded here pending source clarification. This bounded summary neither establishes an intervention benefit nor equates a questionnaire cutoff with an independently adjudicated clinical diagnosis.

Cite this paper

Plain citation

Yudi Xu, Wenjing Ning, Yuyuan Zhang, Yuhao Ba, Huimin Liu, Long Liu, Libo Wang, Chunguang Guo, Hui Xu, Siyuan Weng, Zhaokai Zhou, Zongao Cai, Hongxuan Ma, Ge Zhang, Yanjie Jia, Xinwei Han. Associations Between Cardiovascular Health (Life's Essential 8) and Mental Disorders. Clinical Cardiology. 2024. https://doi.org/10.1002/clc.70019

Author-controlled citation; verify against the publisher version of record.

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Evidence Snapshot

Life’s Essential 8 and depressive symptoms: the consistent NHANES evidence

A cross-sectional NHANES analysis linked higher Life’s Essential 8 scores to lower odds of PHQ-9-defined depressive symptoms. This evidence page is limited to the internally consistent depression results; conflicting anxiety counts and estimates remain unresolved and are not presented as established findings.

Unique total
n=13,028
NHANES 2007–2012 complete-data sample
n=13,028

Key Findings

KF1 The depression evidence is based on a defined complete-data adult survey sample and a symptom threshold.

The reported depression count agrees between Abstract Results and Results §3.1. PHQ-9 ascertainment is a symptom measure, not prospective incident depression.

Evidence for KF1
MeasureValue
analytic participants13,028
participants with PHQ-9 ≥101,206
survey period2007–2012

Source locator: Methods §2.1 Study Population (clc70019-sec-0080), §2.3 Outcomes (clc70019-sec-0100); Results §3.1 (clc70019-sec-0140); Abstract Results

Permalink to KF1

KF2 Higher total LE8 score was associated with lower adjusted odds of prevalent depressive symptoms.

Weighted logistic regression adjusted for age, sex, race, marital status, poverty and education; association per 10-point LE8 increment.

Evidence for KF2
MeasureValue
OR per 10-point LE8 increase0.61
95% confidence interval0.58–0.65
P value<0.001

Source locator: Methods §2.5 Statistical Analysis (clc70019-sec-0120); Results §3.2 (clc70019-sec-0150); Table 2 (clc70019-tbl-0002), Depression column, total-score continuous row and footnotes a–b

Permalink to KF2

KF3 Moderate and high LE8 groups had lower depression odds relative to the low-score group.

The score categories are low 0–49, moderate 50–79 and high 80–100. This compares concurrent health profiles, not the effect of moving a person into a higher category.

Evidence for KF3
MeasureValue
moderate versus lowOR 0.36 (95% CI 0.29–0.43)
high versus lowOR 0.08 (95% CI 0.05–0.13)
P for trend<0.001

Source locator: Methods §2.2 Assessment of Cardiovascular Health Metrics (clc70019-sec-0090); Results §3.2; Table 2 (clc70019-tbl-0002), LE8 total score category rows, Depression column

Permalink to KF3

KF4 Both LE8 health-behavior and health-factor subscores had inverse continuous associations with depressive symptoms.

Separate Table 2 associations per 10-point subscore increase, adjusted for the six stated demographic and socioeconomic factors; not independent causal effects of individual components.

Evidence for KF4
MeasureValue
health-behavior scoreOR 0.70 (95% CI 0.67–0.73)
health-factor scoreOR 0.87 (95% CI 0.83–0.92)
P valuesBoth <0.001

Source locator: Results §3.2 (clc70019-sec-0150); Table 2 (clc70019-tbl-0002), continuous health-behavior and health-factor rows, Depression column and footnotes a–b

Permalink to KF4

Study Design & Analytical Framework

Study profile

Study Design
Cross-sectional secondary analysis of NHANES 2007–2012, restricted here to the consistent depression results
Evidence Type
Survey-weighted observational prevalence association
Unique total
13,028
Population
NHANES adults aged at least 20 years with complete LE8 and outcome data, excluding pregnancy
Primary Endpoint
Prevalent depressive symptoms defined by PHQ-9 score ≥10
Secondary Endpoint
Associations of LE8 health-behavior and health-factor subscores with depressive symptoms; published anxiety results excluded from this evidence page because of unresolved source conflicts
External validation
No

Cohort hierarchy

CohortRolenRelationship
NHANES 2007–2012 complete-data sampleSingle cross-sectional sample; depression findings only in this bounded summary13,028Independent cohort

Data modalities

  • NHANES examination and laboratory measures
  • Dietary and health-behavior questionnaires
  • PHQ-9 symptom questionnaire
  • Survey sampling weights

What This Study Adds

  • Relates a multidomain cardiovascular-health score to concurrently measured depressive symptoms in a nationally sampled adult dataset.
  • Provides mutually consistent total-score, categorical and subscore depression associations while keeping the unresolved anxiety results outside the supported claim set.

Evidence Scope

Supports

  • Survey-weighted associations of LE8 and its subscores with PHQ-9-defined depressive symptoms in the selected 2007–2012 sample.
  • The depression-specific counts and estimates that agree across the abstract, Results and Table 2.

Does Not Establish

  • That interventions improving LE8 prevent or treat depression or anxiety.
  • A causal direction between cardiovascular health and depressive symptoms.
  • Resolved anxiety event counts or effect estimates; these remain excluded.
  • Prospective depression prediction or psychiatric diagnosis by LE8.

Limitations

  • Unresolved anxiety conflict: Abstract Results reports 2,947 anxiety participants and OR 0.78 (95% CI 0.75–0.81), whereas Results §3.1 reports 3,326 and Results §3.3/Table 2 give OR 0.80 (0.77–0.82). This page does not choose between these values; all anxiety estimates and anxiety-based conclusions are excluded. The discrepancy has not been declared corrected.
  • Cross-sectional associations do not determine temporal order, causality or efficacy of a cardiovascular-health intervention.
  • PHQ-9 ≥10 identifies depressive symptoms for this analysis and is not equivalent to an independently adjudicated psychiatric diagnosis.
  • Complete-data selection, self-reported behaviors and residual confounding can affect associations.
  • Supplementary subgroup/sensitivity results and spline plots are outside the independently verified quantitative claim set.

When This Study Is Useful to Cite

  1. CU1: What evidence relates Life’s Essential 8 to depressive symptoms?

    The survey-weighted NHANES analysis reports OR 0.61 per 10 LE8 points for PHQ-9-defined depressive symptoms, CI 0.58–0.65, without causal inference.

    Evidence: KF1, KF2

  2. CU2: How did depressive-symptom odds differ by LE8 category?

    Compared with low LE8, adjusted ORs were 0.36 for moderate and 0.08 for high scores; these are concurrent category associations.

    Evidence: KF3

  3. CU3: Were both LE8 subscore domains associated with depressive symptoms?

    Per 10 points, health-behavior and health-factor ORs were 0.70 and 0.87, respectively, in the reported weighted models.

    Evidence: KF4

What This Study Should Not Be Cited to Claim

  • That interventions improving LE8 prevent or treat depression or anxiety.
  • A causal direction between cardiovascular health and depressive symptoms.
  • Resolved anxiety event counts or effect estimates; these remain excluded.
  • Prospective depression prediction or psychiatric diagnosis by LE8.

Evidence Matrix

Row IDComponentContextFindingEvidence LevelScopeSource LocatorEvidence refs
evidence-kf1The depression evidence is based on a defined complete-data adult survey sample and a symptom threshold.The reported depression count agrees between Abstract Results and Results §3.1. PHQ-9 ascertainment is a symptom measure, not prospective incident depression.analytic participants: 13,028; participants with PHQ-9 ≥10: 1,206; survey period: 2007–2012Survey-weighted cross-sectional observational analysisReported prevalence-odds association or study measurement, not incident disease prediction or an intervention effect.Methods §2.1 Study Population (clc70019-sec-0080), §2.3 Outcomes (clc70019-sec-0100); Results §3.1 (clc70019-sec-0140); Abstract ResultsKF1
evidence-kf2Higher total LE8 score was associated with lower adjusted odds of prevalent depressive symptoms.Weighted logistic regression adjusted for age, sex, race, marital status, poverty and education; association per 10-point LE8 increment.OR per 10-point LE8 increase: 0.61; 95% confidence interval: 0.58–0.65; P value: <0.001Survey-weighted cross-sectional observational analysisReported prevalence-odds association or study measurement, not incident disease prediction or an intervention effect.Methods §2.5 Statistical Analysis (clc70019-sec-0120); Results §3.2 (clc70019-sec-0150); Table 2 (clc70019-tbl-0002), Depression column, total-score continuous row and footnotes a–bKF2
evidence-kf3Moderate and high LE8 groups had lower depression odds relative to the low-score group.The score categories are low 0–49, moderate 50–79 and high 80–100. This compares concurrent health profiles, not the effect of moving a person into a higher category.moderate versus low: OR 0.36 (95% CI 0.29–0.43); high versus low: OR 0.08 (95% CI 0.05–0.13); P for trend: <0.001Survey-weighted cross-sectional observational analysisReported prevalence-odds association or study measurement, not incident disease prediction or an intervention effect.Methods §2.2 Assessment of Cardiovascular Health Metrics (clc70019-sec-0090); Results §3.2; Table 2 (clc70019-tbl-0002), LE8 total score category rows, Depression columnKF3
evidence-kf4Both LE8 health-behavior and health-factor subscores had inverse continuous associations with depressive symptoms.Separate Table 2 associations per 10-point subscore increase, adjusted for the six stated demographic and socioeconomic factors; not independent causal effects of individual components.health-behavior score: OR 0.70 (95% CI 0.67–0.73); health-factor score: OR 0.87 (95% CI 0.83–0.92); P values: Both <0.001Survey-weighted cross-sectional observational analysisReported prevalence-odds association or study measurement, not incident disease prediction or an intervention effect.Results §3.2 (clc70019-sec-0150); Table 2 (clc70019-tbl-0002), continuous health-behavior and health-factor rows, Depression column and footnotes a–bKF4

Q&A

Which part of the paper is summarized here?

Only the internally consistent depression analysis. The full publication also analyzes anxiety, but its unresolved count and effect-estimate conflicts are explicitly excluded from this page's supported findings.

Evidence: KF1, KF2

How were depressive symptoms defined?

PHQ-9 score ≥10. The paper reports 1,206 such participants among 13,028 adults in the analytic sample.

Evidence: KF1

What is the association per 10 LE8 points?

The adjusted, survey-weighted depression OR is 0.61 (95% CI 0.58–0.65), P<0.001. It is a prevalence-odds association, not a demonstrated preventive effect.

Evidence: KF2

What did the category and subscore analyses add?

Relative to low LE8, moderate and high groups had ORs 0.36 and 0.08. Per 10 subscore points, health-behavior and health-factor ORs were 0.70 and 0.87. The stated confidence intervals and covariate scope remain essential.

Evidence: KF3, KF4

Does this show that improving cardiovascular health treats depression?

No. Concurrent cross-sectional measurements cannot resolve temporal direction, reverse causation or residual confounding. No LE8-targeted treatment was tested.

Evidence: KF1, KF2

Concepts & Entities

Conditions

depressive symptomscardiovascular health

Populations

US NHANES adults aged at least 20 years

Outcomes

PHQ-9-defined prevalent depressive symptoms

Methods

survey-weighted logistic regressioncross-sectional analysis

Data Types

PHQ-9 responseshealth-behavior questionnairesexamination and laboratory measures

Models & Tools

Life’s Essential 8PHQ-9

Datasets & Cohorts

NHANES 2007–2012

Related Research

Publication & Provenance

DOI
https://doi.org/10.1002/clc.70019
Publisher
https://doi.org/10.1002/clc.70019
Pmc Url
https://pmc.ncbi.nlm.nih.gov/articles/PMC11420513/
PubMed
https://pubmed.ncbi.nlm.nih.gov/39314085/
PMCID
PMC11420513
Pmid
39314085
Version
Formal published article archived as PMC11420513.1; no scientific correction relation returned by the targeted Crossref metadata check on 2026-10-26. This is not an exhaustive absence-of-correction claim.
Evidence Basis
Formal Methods §§2.1–2.5, Results §§3.1–3.2 and text-encoded Table 2 depression columns. Anxiety counts and effects are excluded because Abstract versus Results/Table 2 conflict.
Source Verification Scope
Formal Methods, Results and text-encoded tables were checked directly. No original statistical reanalysis and no source figures reproduced.
License
CC BY 4.0, as stated in article-level permissions.
Source Sha256
0bdc92cabe8ddd3dea781e53aadec051e4d6142bbce9091a93a6ec1cb2041f5b
Author-controlled evidence page for this publication. This page provides an evidence-oriented summary and does not replace the publisher's version of record. The explicitly disclosed inconsistent findings are excluded from the supported evidence scope.

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Study-level author-maintained evidence summary. Not participant-level data and not a ready-to-pool meta-analysis dataset. For formal citation, use the original article DOI.

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