Young adults who feel down or depressed are more likely to develop cardiovascular disease (CVD) and have poor heart health, according to a new study led by Johns Hopkins Medicine researchers who analyzed data from more than a half million people between the ages of 18 and 49. The findings add to a growing body of evidence connecting CVD with depression among young and middle-aged adults, and suggest the relationship between the two could begin in early adulthood.

The study, published Jan. 23 in the Journal of the American Heart Association, also found that young adults who self-reported feeling depressed or having poor mental health days had higher rates of heart attacks, strokes and risk factors for heart disease compared with their peers without mental health issues.

"When you're stressed, anxious or depressed, you may feel overwhelmed, and your heart rate and blood pressure rises. It's also common that feeling down could lead to making poor lifestyle choices like smoking, drinking alcohol, sleeping less and not being physically active—all adverse conditions that negativity impact your heart," says Garima Sharma, M.B.B.S., associate professor of medicine at Johns Hopkins Medicine and senior author of the study.

Sharma and her colleagues looked at data from 593,616 adults who participated in the Behavioral Risk Factor Surveillance System, a self-reported, nationally representative survey conducted between 2017 and 2020. The survey included questions about whether they have ever been told they have a depressive disorder, how many days they experienced poor mental health in the past month (0 days, 1–13 days or 14–30 days), whether they had experienced a heart attack, stroke or chest pain, and if they had cardiovascular disease risk factors.

Risk factors include high blood pressure, high cholesterol, being overweight/obese, smoking, diabetes, and poor physical activity and diet. People who had two or more of these risk factors were considered to have suboptimal cardiovascular health.

One in five adults self-reported having depression or frequently feeling low, with the study noting that there could have been higher rates during the last year of the study, which was the first year of the COVID-19 pandemic. According to the U.S. Centers for Disease Control and Prevention, the percentage of U.S. adults who experienced depression or anxiety jumped from 36.4% to 41.5% during the first year of the pandemic, with the highest spike among people ages 18 to 29.

The study revealed that, overall, those who self-reported several days of feeling down had a stronger link to cardiovascular disease and poor heart health. Compared with people who reported no poor mental health days in the past 30 days, participants who reported up to 13 poor mental health days had 1.5 times higher odds of CVD, while those with 14 or more days of poor mental health had double the odds. Associations between poor mental health and CVD did not differ significantly by gender or urban/rural status.

"The relationship between depression and heart disease is a two-way street. Depression increases your risk of heart issues, and those with heart disease experience depression," says Yaa Adoma Kwapong, M.D., M.P.H., a postdoctoral research fellow at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and lead author of the study.

"Our study suggests that we need to prioritize mental health among young adults and perhaps increase screening and monitoring for heart disease in people with mental health conditions and vice versa to improve overall heart health."

Kwapong says this new study only provides a snapshot of cardiovascular health among young people with depression, and that new studies need to look at how depression affects cardiovascular health over time.