title: Depressive symptoms and cardiovascular health by the American Heart Association's definition in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
abstract: BACKGROUND
  Depressive symptoms are associated with increased incident and recurrent cardiovascular events. In 2010, the American Heart Association published the Life's Simple 7, a metric for assessing cardiovascular health as measured by 4 health behaviors (smoking, physical activity, body mass index, diet) and 3 biological measures (cholesterol, blood pressure, glucose). The association between depressive symptoms and the Life's Simple 7 has not yet been explored.
  
  
  METHODS
  Data from 20,093 participants ≥45 years of age who enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007 and who had complete data available on Life's Simple 7 components were used for these analyses. The prevalence of ideal, intermediate, and poor health on each Life's Simple 7 component and total Life's Simple 7 scores were compared between participants with and without depressive symptoms. Depressive symptoms were measured using the 4-item Centers for Epidemiologic Studies of Depression scale.
  
  
  RESULTS
  Participants with depressive symptoms were more likely to have poor levels on each of the Life's Simple 7 components other than cholesterol [adjusted prevalence ratios (95% CI): smoking 1.41 (1.29-1.55); physical activity 1.38 (1.31-1.46); body mass index 1.09 (1.04-1.15); diet 1.08 (1.06-1.10); blood pressure 1.11 (1.02-1.21); glucose 1.24 (1.09-1.41)]. There was a graded association between increasing depressive symptoms and lower total Life's Simple 7 score.
  
  
  CONCLUSIONS
  Depressive symptoms are associated with worse cardiovascular health on the overall Life's Simple 7 and on individual components representing both health behaviors and biological factors.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University, New York, New York, United States of America. ik2293@columbia.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: April P
authors.initials: AP
authors.lastname: Carson
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D001741:Black or African American; D000368:Aged; D000572:American Heart Association; D003327:Coronary Disease / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People