{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T20:13:58Z","timestamp":1793736838170,"version":"4.6.1"},"reference-count":44,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007155","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N013166\/1-LGH\/MS\/MED2525"],"award-info":[{"award-number":["MR\/N013166\/1-LGH\/MS\/MED2525"]}],"id":[{"id":"10.13039\/501100007155","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Although anxiety disorder and depression increase the risk of cardiovascular disease (CVD), few studies have examined their underlying mechanisms systematically, particularly contrasting the difference between the two of them. Our study aimed to examine the extent to which lifestyle, physical, and metabolic factors mediate the associations of anxiety disorder and depression with incident CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted using UK Biobank. Anxiety disorder, depression, and incident CVD were ascertained through linkage to hospital and death records. A causal mediation analysis was performed for anxiety disorder and depression, separately examining multiple potential lifestyle, physical, and metabolic mediators. Cox proportional hazard models and log-linear models were used to derive indirect effect estimates and proportions mediated. A total of 254 695 participants were included. Both anxiety disorder [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.15\u20132.30] and depression (HR 2.15, 95% CI 1.75\u20132.64) were associated with CVD after adjusting for sociodemographic confounders. Among lifestyle and physical factors, the strongest mediators were current smoking and higher waist\u2013hip ratio which accounted for 11.9% and 13.4% of the excess risk from anxiety disorder, and 17.3% and 14.0% from depression, respectively. The strongest metabolic mediators were systolic blood pressure for anxiety disorder (10.4%) and C-reactive protein (10.8%) for depression. Systolic blood pressure was the weakest mediator for depression (4.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lifestyle and physical pathways to incident CVD may be common to both anxiety disorder and depression, but shared metabolic pathways seem unlikely. Our findings inform which risk factors to target among people with anxiety disorder or depression in order to reduce their higher risk of developing CVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf110","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T08:51:22Z","timestamp":1740473482000},"source":"Crossref","is-referenced-by-count":8,"title":["Shared and distinct pathways from anxiety disorder and depression to cardiovascular disease: a UK Biobank prospective cohort study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8711-8420","authenticated-orcid":false,"given":"Shinya","family":"Nakada","sequence":"first","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow , Glasgow G12 8TB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Celis-Morales","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow G12 8TA ,","place":["UK"]},{"name":"Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Cat\u00f3lica del Maule , Talca ,","place":["Chile"]},{"name":"Centro de Investigaci\u00f3n en Medicina de Altura (CEIMA), Universidad Arturo Prat , Iquique ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8898-7035","authenticated-orcid":false,"given":"Jill P","family":"Pell","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow , Glasgow G12 8TB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-9025","authenticated-orcid":false,"given":"Frederick K","family":"Ho","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow , Glasgow G12 8TB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"2025032017525467200_zwaf110-B1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/01.HCR.0000265036.24157.e7","article-title":"Prevalence of anxiety disorders in men and women with established coronary heart disease","volume":"27","author":"Todaro","year":"2007","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2025032017525467200_zwaf110-B2","doi-asserted-by":"crossref","first-page":"483","DOI":"10.5694\/mja13.10153","article-title":"Screening, referral and treatment for depression in patients with coronary heart disease","volume":"198","author":"Colquhoun","year":"2013","journal-title":"Med J Aust"},{"key":"2025032017525467200_zwaf110-B3","doi-asserted-by":"crossref","first-page":"17024","DOI":"10.1038\/nrdp.2017.24","article-title":"Anxiety disorders","volume":"3","author":"Craske","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"2025032017525467200_zwaf110-B4","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41572-023-00454-1","article-title":"Major depressive disorder","volume":"9","author":"Marx","year":"2023","journal-title":"Nat Rev Dis Primers"},{"key":"2025032017525467200_zwaf110-B5","doi-asserted-by":"crossref","first-page":"e010859","DOI":"10.1161\/JAHA.118.010859","article-title":"Sex- and gender-stratified risks of psychological factors for incident ischemic heart disease systematic review and meta-analysis","volume":"8","author":"Smaardijk","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2025032017525467200_zwaf110-B6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","author":"GBD 2019 Mental Disorders Collaborators","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"2025032017525467200_zwaf110-B7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jad.2021.10.022","article-title":"Trends in the incidence and DALYs of anxiety disorders at the global, regional, and national levels: estimates from the Global Burden of Disease Study 2019","volume":"297","author":"Xiong","year":"2022","journal-title":"J Affect Disord"},{"key":"2025032017525467200_zwaf110-B8","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.maturitas.2017.09.005","article-title":"Exploring the path between depression, anxiety and 10-year cardiovascular disease incidence, among apparently healthy Greek middle-aged adults: the ATTICA study","volume":"106","author":"Kollia","year":"2017","journal-title":"Maturitas"},{"key":"2025032017525467200_zwaf110-B9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s10865-015-9637-2","article-title":"The role of inflammatory markers in explaining the association between depression and cardiovascular hospitalisations","volume":"38","author":"Hiles","year":"2015","journal-title":"J Behav Med"},{"key":"2025032017525467200_zwaf110-B10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/978-3-319-48382-5_12","article-title":"Insulin resistance, obesity and lipotoxicity","volume":"960","author":"Yaz\u0131c\u0131","year":"2017","journal-title":"Adv Exp Med Biol"},{"key":"2025032017525467200_zwaf110-B11","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s00127-011-0365-9","article-title":"Chronic medical conditions mediate the association between depression and cardiovascular disease mortality","volume":"47","author":"Atlantis","year":"2012","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2025032017525467200_zwaf110-B12","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"2025032017525467200_zwaf110-B13","doi-asserted-by":"crossref","first-page":"3547","DOI":"10.1093\/eurheartj\/ehz564","article-title":"Mortality reduction with physical activity in patients with and without cardiovascular disease","volume":"40","author":"Jeong","year":"2019","journal-title":"Eur Heart J"},{"key":"2025032017525467200_zwaf110-B14","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1016\/j.mayocp.2021.01.036","article-title":"Nonlinear associations between cumulative dietary risk factors and cardiovascular diseases, cancer, and all-cause mortality: a prospective cohort study from UK Biobank","volume":"96","author":"Petermann-Rocha","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"2025032017525467200_zwaf110-B15","author":"World Health Organization"},{"key":"2025032017525467200_zwaf110-B16","author":"WHO Consultation on Obesity & World Health Organization"},{"key":"2025032017525467200_zwaf110-B17","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/HJH.0000000000002453","article-title":"2020 International Society of Hypertension global hypertension practice guidelines","volume":"38","author":"Unger","year":"2020","journal-title":"J Hypertens"},{"key":"2025032017525467200_zwaf110-B18","author":"World Health Organization"},{"key":"2025032017525467200_zwaf110-B19","first-page":"e563","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"2025032017525467200_zwaf110-B20","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1161\/01.HYP.0000130484.20501.df","article-title":"C-reactive protein: risk marker or mediator in atherothrombosis?","volume":"44","author":"Jialal","year":"2004","journal-title":"Hypertension"},{"key":"2025032017525467200_zwaf110-B21","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1093\/eurheartj\/eht462","article-title":"Depression and cardiovascular disease: a clinical review","volume":"35","author":"Hare","year":"2014","journal-title":"Eur Heart J"},{"key":"2025032017525467200_zwaf110-B22","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1017\/S0033291719002678","article-title":"Evidence for causal effects of lifetime smoking on risk for depression and schizophrenia: a Mendelian randomisation study","volume":"50","author":"Wootton","year":"2020","journal-title":"Psychol Med"},{"key":"2025032017525467200_zwaf110-B23","doi-asserted-by":"crossref","first-page":"13807","DOI":"10.1038\/s41598-020-70458-4","article-title":"Associations of cigarette smoking with psychiatric disorders: evidence from a two-sample Mendelian randomization study","volume":"10","author":"Yuan","year":"2020","journal-title":"Sci Rep"},{"key":"2025032017525467200_zwaf110-B24","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/ije\/dyy223","article-title":"Using genetics to understand the causal influence of higher BMI on depression","volume":"48","author":"Tyrrell","year":"2019","journal-title":"Int J Epidemiol"},{"key":"2025032017525467200_zwaf110-B25","doi-asserted-by":"crossref","first-page":"100992","DOI":"10.1016\/j.eclinm.2021.100992","article-title":"Role of inflammation in depression and anxiety: tests for disorder specificity, linearity and potential causality of association in the UK Biobank","volume":"38","author":"Ye","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025032017525467200_zwaf110-B26","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1192\/j.eurpsy.2023.2425","article-title":"Individual and joint associations of anxiety disorder and depression with cardiovascular disease: a UK Biobank prospective cohort study","volume":"66","author":"Nakada","year":"2023","journal-title":"Eur Psychiatry"},{"key":"2025032017525467200_zwaf110-B27","doi-asserted-by":"crossref","first-page":"102063","DOI":"10.1016\/j.eclinm.2023.102063","article-title":"Psychiatric disorders and subsequent risk of cardiovascular disease: a longitudinal matched cohort study across three countries","volume":"61","author":"Shen","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2025032017525467200_zwaf110-B28","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1007\/s00125-020-05131-6","article-title":"Major depressive disorder and cardiometabolic diseases: a bidirectional Mendelian randomisation study","volume":"63","author":"Tang","year":"2020","journal-title":"Diabetologia"},{"key":"2025032017525467200_zwaf110-B29","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.drugalcdep.2014.10.022","article-title":"Association of anxiety disorders with the risk of smoking behaviors: a meta-analysis of prospective observational studies","volume":"145","author":"Jiang","year":"2014","journal-title":"Drug Alcohol Depend"},{"key":"2025032017525467200_zwaf110-B30","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1001\/archpsyc.55.2.161","article-title":"Major depression and stages of smoking. A longitudinal investigation","volume":"55","author":"Breslau","year":"1998","journal-title":"Arch Gen Psychiatry"},{"key":"2025032017525467200_zwaf110-B31","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jpsychores.2011.03.004","article-title":"Associations of mood and anxiety disorders with obesity: comparisons by ethnicity","volume":"71","author":"Bodenlos","year":"2011","journal-title":"J Psychosom Res"},{"key":"2025032017525467200_zwaf110-B32","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.psychres.2009.04.015","article-title":"Depression and obesity: a meta-analysis of community-based studies","volume":"178","author":"de Wit","year":"2010","journal-title":"Psychiatry Res"},{"key":"2025032017525467200_zwaf110-B33","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.neubiorev.2021.08.031","article-title":"Association between anxiety and hypertension in adults: a systematic review and meta-analysis","volume":"131","author":"Lim","year":"2021","journal-title":"Neurosci Biobehav Rev"},{"key":"2025032017525467200_zwaf110-B34","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jad.2020.09.025","article-title":"Depression and inflammation among children and adolescents: a meta-analysis","volume":"277","author":"Colasanto","year":"2020","journal-title":"J Affect Disord"},{"key":"2025032017525467200_zwaf110-B35","volume-title":"Publications and Reports of the Surgeon General. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General","author":"Centers for Disease C, Prevention, National Center for Chronic Disease P, Health P, Office on S, Health","year":"2010"},{"key":"2025032017525467200_zwaf110-B36","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1038\/nrcardio.2016.181","article-title":"Depression and coronary heart disease","volume":"14","author":"Carney","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"2025032017525467200_zwaf110-B37","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1176\/appi.ajp.20230922","article-title":"Psychotropic drug-related weight gain and its treatment","volume":"181","author":"McIntyre","year":"2024","journal-title":"Am J Psychiatry"},{"key":"2025032017525467200_zwaf110-B38","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0753-3322(00)80065-7","article-title":"Adrenocortical responses to psychological stress and risk for hypertension","volume":"54","author":"al\u2019Absi","year":"2000","journal-title":"Biomed Pharmacother"},{"key":"2025032017525467200_zwaf110-B39","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.neuron.2020.06.002","article-title":"The bidirectional relationship of depression and inflammation: double trouble","volume":"107","author":"Beurel","year":"2020","journal-title":"Neuron"},{"key":"2025032017525467200_zwaf110-B40","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1056\/NEJMoa0707402","article-title":"Genetically elevated C-reactive protein and ischemic vascular disease","volume":"359","author":"Zacho","year":"2008","journal-title":"N Engl J Med"},{"key":"2025032017525467200_zwaf110-B41","first-page":"739","article-title":"Anxiety and dyslipidemia among primary health care professionals: a cross-sectional study","volume":"71","author":"Barbosa","year":"2022","journal-title":"Work"},{"key":"2025032017525467200_zwaf110-B42","doi-asserted-by":"crossref","first-page":"q1645","DOI":"10.1136\/bmj.q1645","article-title":"GLP-1 agonists: US sees 700% increase over four years in number of patients without diabetes starting treatment","volume":"386","author":"Mahase","year":"2024","journal-title":"BMJ"},{"key":"2025032017525467200_zwaf110-B43","doi-asserted-by":"crossref","first-page":"e525","DOI":"10.3399\/bjgp20X710873","article-title":"Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care","volume":"70","author":"Curtis","year":"2020","journal-title":"Br J Gen Pract"},{"key":"2025032017525467200_zwaf110-B44","doi-asserted-by":"crossref","DOI":"10.3399\/BJGPO.2021.0020","article-title":"Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study","volume":"5","author":"Bogowicz","year":"2021","journal-title":"BJGP Open"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwaf110\/62178297\/zwaf110.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwaf110\/62178297\/zwaf110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T04:50:42Z","timestamp":1742619042000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article\/doi\/10.1093\/eurjpc\/zwaf110\/8043200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":44,"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwaf110","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.02.14.25322279","asserted-by":"object"}]},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]},"article-number":"zwaf110"}}