AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Linkage Between Psychological Distress and the Risk of Cardiovascular Disease Development in Rural Caregivers: Mediating Role of Engagement to AHA Life’s Essential 8
By Chung M, Ahn S, Moser DK
Background: Adults who provide informal care commonly experience severe psychological distress such as caregiving burden and depressive symptoms. They are also at increased risk of hypertension and cardiovascular disease (CVD) compared with non-caregivers. Despite the American Heart Association’s Life’s Essential 8 (LE8) framework outlining key behaviors and factors for CVD prevention, little is known about rural caregivers’ self-care engagement in LE8 metrics and whether the engagement mediates the association between psychological distress and CVD risk. Purpose: The aim of this study was to examine whether the association between psychological distress (i.e., caregiving burden and depressive symptoms) and CVD risk is mediated by self-care engagement in LE8 among rural caregivers. Methods: This cross-sectional secondary data analysis used baseline data from rural caregivers enrolled in a CVD risk-reduction program. Caregiving burden was assessed using the Zarit Burden Interview. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Engagement in LE8 metrics was assessed using the Cardiovascular Health Status (CHS), which is a composite score of LE8 metrics (range: 0 - 100) derived from a food frequency survey (Health Eating Index 2015 score), physical examination measures (i.e., lipids, blood pressure), prescribed medication, comorbidities, and validated survey measures. CVD risk was assessed using the Framing Risk Score, which estimates the 10-year probability of developing clinical CVD based on physical examination values obtained above. Mediation analyses were conducted using the SPSS PROCESS macro program (Model 4) with 5,000 bootstrap samples. Results: Among 295 rural caregivers (mean age = 55.3 years; 76% female), overall engagement in LE8 is poor (mean CHS = 57.3) and 30% had low engagement in LE8 (CHS score < 50). Based on the Framingham Risk Score, 60% were at intermediate risk (score 10-20%) for CVD in next 10 years. Caregiving burden (Figure 1) showed significant direct effect on CVD risk (b = -.0317, 95% CI: -.0602, -.0032) and indirect effect on CVD risk through engagement in LE8 (b = .0107, 95% CI: .0029, .0205). Depressive symptoms (Figure 2) also had significant direct (b = -.2229, 95% CI: -.3167, -.1292) on CVD risk and indirect effect via engagement in LE8 on the CVD risk (b= .1160, 95% CI: .0668, .1753). Conclusion: Rural caregivers reported low engagement with the AHA’s LE8, and more than half were at high risk of developing CVD within the next 10 years. Significant mediating effects indicated that higher caregiving burden and depressive symptoms were associated with lower engagement in LE8, which in turn increased risk of 10-year CVD. Screening for and addressing caregiving burden and depressive symptoms, along with interventions that support rural caregiver’s LE8-based self-care, are critical to reducing their CVD development.