The burden of chronic anxiety and depression symptomatology on 20-year cardiovascular disease incidence: The ATTICA study (2002–2022)

Abstract

Background: The aim of this study was to explore the associations between symptoms of depression and anxiety on 20-year cardiovascular disease (CVD) incidence among apparently healthy Greek adults. Methods: In the context of a population-based, prospective health survey, the ATTICA study (2002–2022), 853 adult participants without previous CVD history [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent evaluations regarding psychological factors (depression through ZDRS and anxiety through STAI scales), lifestyle factors (smoking, diet, physical activity) and medical conditions (obesity, hypertension, hypercholesterolemia, diabetes mellitus) at both baseline and 10-year follow-up examinations. CVD incidence was assessed based on medical records and hospital data. Cox proportional hazard models were developed to evaluate the association between psychological symptoms on the 20-year CVD incidence, after adjusting for various characteristics. Results: The results indicated that the chronic burden of depression and anxiety was independently associated with increased CVD risk during the 20-year follow-up period (crude hazard ratios of cumulative at baseline and at 10-year follow-up depressive symptoms score on CVD incidence was 1.04 95%CI (1.03, 1.05), and for anxiety score was 1.03 95%CI (1.02, 1.04)); the hazard ratios were higher especially for younger participants and those who did not adhere steadily to the Mediterranean diet during the follow-up period. Conclusions: Based on our findings, standardized psychological assessments focusing on depression and anxiety should be integrated as a distinct and additional component within the preventive strategies for CVD implemented by health authorities at the population level. © 2025 Elsevier Inc