Association of Poor Mental Health and Cardiovascular Events Among Middle-Aged and older people's: A population-based case control study

Introduction: Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, and growing evidence suggests that poor mental health may play an important role in their onset. However, the association between mental disorders and cardiovascular events (CVE) among middle-aged and older adults in Iran has not been well explored. Methods: This population based case control study using data from the Sina Electronic Health Record (SinaEHR®) system between 2017 and 2024. A total of 14,674 individuals aged ≥ 50 years were included, comprising 7,337 patients with confirmed CVE and 7,337 frequency-matched controls by age and sex without CVE. Mental disorders were identified based on ICD-10 codes (F00–F99), and cardiovascular outcomes included ischemic heart disease and stroke events. Logistic regression was applied to estimate crude and adjusted odds ratios (OR, AOR) with 95% confidence intervals (CI) controlling for sociodemographic lifestyle and clinical variables. Results : Mental disorders were significantly more common among CVE cases (60.8%) compared to controls (39.2%, p_value < 0.001). After adjustment, mental disorders remained independently associated with CVE (AOR = 1.69, 95% CI: 1.52–1.88). Depression (AOR = 1.53, 95% CI: 1.22–1.92) and anxiety (AOR = 1.94, 95% CI: 1.56–2.40) were particularly strong predictors. Traditional risk factors also showed significant associations like advanced age (≥ 70 years, AOR = 3.39 compared to 50–59), overweight and obesity (AOR: 2.99–3.10 compared to healthy weight), hypertension (AOR = 2.12), hypercholesterolemia (AOR = 1.86), diabetes (AOR = 1.17), smoking (AOR = 1.72), and drug abuse (AOR = 2.30). Conclusion : Poor mental health especially depression and anxiety is an independent risk factor for cardiovascular events in middle-aged and older adults. Integrating mental health assessment and care into cardiovascular prevention strategies could reduce CVE burden in this vulnerable population.