To examine the extent to which lifestyle, physical, and metabolic factors mediate the associations of anxiety disorder and depression with incident cardiovascular disease (CVD), particularly contrasting the differences between the two conditions.
Key Findings:
Anxiety disorder (HR 1.62, 95% CI 1.15–2.30) and depression (HR 2.15, 95% CI 1.75–2.64) are associated with increased risk of CVD after adjusting for sociodemographic factors.
Current smoking and higher waist–hip ratio were significant lifestyle mediators for both conditions.
Systolic blood pressure was a strong metabolic mediator for anxiety disorder, while C-reactive protein was significant for depression.
Interpretation:
Lifestyle and physical pathways to incident CVD are common to both anxiety disorder and depression, but shared metabolic pathways appear unlikely due to differing biological mechanisms.
Limitations:
The study may not account for all potential confounding factors.
The reliance on self-reported data for lifestyle factors may introduce bias.
The large sample size may not fully mitigate the impact of unmeasured confounders.
Conclusion:
Targeting specific risk factors such as smoking and central adiposity may help reduce the higher risk of CVD in individuals with anxiety disorder or depression, suggesting the need for tailored intervention strategies.
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