Maturitas · Apr 28, 2026

Cardiovascular risk among middle-aged and older adults without standard modifiable risk factors ('SMuRF-less' adults) but persistently depressed: Evidence from two prospective cohorts

By Ma C, Zhao DF, Huo RR et al.

OBJECTIVE: While depressive symptoms are a known risk factor for cardiovascular disease (CVD), their influence over time in individuals without standard modifiable risk factors ('SMuRF-less' adults) is unclear. This study examined the association between depressive symptoms and incident CVD in SMuRF-less middle-aged and older adults. METHODS: This prospective cohort study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS; n = 2095) and the English Longitudinal Study of Ageing (ELSA; n = 798). Depressive symptoms were assessed at baseline and at a roughly 2-year follow-up using the CES-D scale. Participants were categorized into four patterns: 'Never', 'Onset', 'Remission', and 'Persistence'. The primary outcome was the first occurrence of self-reported, physician-diagnosed CVD (heart disease or stroke). Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI). RESULTS: Over follow-up, compared with the Never group, participants with Onset (CHARLS: HR 1.55, 95% CI 1.16-2.08; ELSA: HR 1.28, 95% CI 1.01-1.62) and Persistence (CHARLS: HR 2.11, 95% CI 1.68-2.65; ELSA: HR 1.77, 95% CI 1.12-2.79) depressive symptoms had a significantly higher risk of incident CVD. The Remission group did not show a significantly elevated risk (CHARLS: HR 1.15, 95% CI 0.87-1.52; ELSA: HR 1.14, 95% CI 0.71-1.82). A dose-response relationship was observed, with higher cumulative depressive symptom scores associated with linearly increasing CVD risk. CONCLUSIONS: Among SMuRF-less middle-aged and older adults, the onset and persistence of depressive symptoms were associated with an increased risk of incident CVD.

doi.org/10.1016/j.maturitas.2026.108967 PubMed 42066665 Populations